title: Large Contaminated Ventral Hernia Repair Using Component Separation Technique with Synthetic Mesh.
abstract: BACKGROUND
  Large ventral hernia repair represents a major reconstructive surgical challenge, especially under contaminated conditions. Synthetic mesh is usually avoided in these circumstances because of fear of mesh infection, although evidence is outdated and does not regard new materials and techniques. The authors evaluated the safety of synthetic mesh in large contaminated ventral hernia repair.
  
  
  METHODS
  All large ventral hernias repaired with the components separation technique and polypropylene mesh were included in analysis. Primary outcomes were wound and medical complications, with a focus on surgical-site infection and mesh removal. For risk analysis, patients were stratified by surgical wound class, Ventral Hernia Working Group grade, and modified Ventral Hernia Working Group grade.
  
  
  RESULTS
  One hundred thirty-seven patients were included, with a mean age of 58.6 years, mean body mass index of 26.6 cm2, and mean defect size of 235.6 cm2. Surgical-site infection and total wound complication rates were 16.1 and 48.9 percent, respectively. The surgical wound class distribution of surgical-site infections was as follows: clean, five of 56 (9.1 percent); clean-contaminated, five of 34 (14.7 percent); contaminated, three of 19 (15.8 percent); and dirty/infected, nine of 28 (32.1 percent). Seven meshes (5.1 percent) needed removal, two after clean repairs, three after clean-contaminated repairs, and two after dirty/infected repairs. Surgical wound class (OR, 1.77; 95 percent CI, 1.20 to 2.61) and Ventral Hernia Working Group grade (OR, 2.31; 95 percent CI, 1.24 to 4.28) were predictors of surgical-site infection.
  
  
  CONCLUSIONS
  Rate of surgical-site infection after large contaminated ventral hernia repair with synthetic mesh is considerable but with a low mesh removal rate.
authors.affiliation: Nijmegen, The Netherlands From the Departments of Plastic and Reconstructive Surgery and General Surgery, Radboud University Medical Center.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Slater
authors.forename: Loes
authors.initials: L
authors.lastname: Knaapen
authors.forename: Willem J V
authors.initials: WJV
authors.lastname: Bökkerink
authors.forename: Marleen J A
authors.initials: MJA
authors.lastname: Biemans
authors.forename: Otmar R
authors.initials: OR
authors.lastname: Buyne
authors.forename: Dietmar J O
authors.initials: DJO
authors.lastname: Ulrich
authors.forename: Robert P
authors.initials: RP
authors.lastname: Bleichrodt
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006555:Hernia, Ventral / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult