title: Active Staphylococcus aureus infection: Is it a contra-indication to the repair of complex hernias with synthetic mesh? A prospective observational study on the outcomes of synthetic mesh replacement, in patients with chronic mesh infection caused by Staphylococcus aureus.
abstract: BACKGROUND
  The management of chronic mesh infection is challenging and controversial. The use of synthetic material to repair the abdominal wall in the infected setting is not recommended, especially in the presence of active infection caused by Staphylococcus aureus.
  
  
  METHODS
  This is a prospective observational study designed to evaluate the outcomes in patients with active mesh infection caused by Staphylococcus aureus. Patients underwent simultaneous removal and replacement of polypropylene mesh. The treatment protocol included the complete removal of infected mesh, followed by the anatomical reconstruction, and reinforcement of the abdominal wall using a new onlay polypropylene mesh. Early and late wound complications, medical complications, and hernia recurrences were analyzed.
  
  
  RESULTS
  From 2006 until 2014, 22 patients with a mean age of 57.2 years and mean BMI of 29,3 kg/m2 were studied. Sinuses were present in 21 patients. A recurrent ventral hernia was observed in 14 patients; two patients required a complex abdominal wall reconstruction due to enteric fistulas. Bowel resections or other potentially contaminated procedures were associated in 10 patients. Fourteen patients (63.6%) had an uneventful postoperative course; 5 (22.7%) patients had wound infections requiring debridement and three required partial (2) or total (1) mesh removal. Two patients died due to medical complications. Adverse results on long-term follow-up included one hernia recurrence after complete mesh removal and one persistent sinus after partial mesh removal requiring a reoperation to remove mesh remnants. All of the patients were considered free of infection after a mean follow-up of 44 months.
  
  
  CONCLUSIONS
  Synthetic mesh replacement in patients with active Staphylococcus aureus infection has an acceptable incidence of postoperative wound infection and prevents hernia recurrence. Large-pore polypropylene mesh is a suitable material to be used in the infected surgical field as an onlay graft.
authors.affiliation: General and Trauma Surgery, Department of Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil. Electronic address: claudio.birolini@hc.fm.usp.br.
authors.forename: Claudio
authors.initials: C
authors.lastname: Birolini
authors.affiliation: General and Trauma Surgery, Department of Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Jocielle Santos
authors.initials: JS
authors.lastname: de Miranda
authors.affiliation: General and Trauma Surgery, Department of Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Edivaldo Massazo
authors.initials: EM
authors.lastname: Utiyama
authors.affiliation: General and Trauma Surgery, Department of Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Samir
authors.initials: S
authors.lastname: Rasslan
authors.affiliation: General and Trauma Surgery, Department of Surgery, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Dario
authors.initials: D
authors.lastname: Birolini
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D000075202:Contraindications; D003646:Debridement; D020878:Device Removal / Q000379:methods; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D013203:Staphylococcal Infections / Q000150:complications* / Q000601:surgery; D013211:Staphylococcus aureus; D013526:Surgical Mesh / Q000009:adverse effects / Q000382:microbiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
chemical_list: D011126:Polypropylenes
keywords: Abdominal wall reconstruction; Mesh infection; Single-staged repair; Staphylococcus aureus; Ventral hernia