title: The routine use of prosthetic mesh in austere environments: dogma vs data.
abstract: BACKGROUND
  Mesh repair has become the standard in adult hernia repairs. Mesh infection is an uncommon but potentially devastating complication. Currently, there is widespread dogma against the use of prosthetic mesh (PM) in deployed or austere environments but little available data to support or refute this bias.
  
  
  METHODS
  Retrospective review of all hernia repairs over 1 year in a forward deployed surgical unit in Afghanistan. Demographics, hernia type, repair performed, and mesh type were evaluated. Follow-up was completed up to 6 weeks and then as needed for up to a year, and complications to include infection were recorded.
  
  
  RESULTS
  Sixty-six patients were identified, mean age was 38 (range 3 to 80) and 98% were male. Single-dose perioperative antibiotics and standard sterile technique were used in all cases. The majority (70%) had PM placed. The mean operative time was 54 min, and mean estimated blood loss was less than 25 cm(3). The vast majority of our hernias were inguinal (95%) with 1 ventral and 2 umbilical hernias. In the PM group, there were no surgical site infections, no mesh infections, and no mesh explantation or reoperation. There were no recurrences in either group identified at up to 1-year postoperation. There was no statistically significant difference in any outcome measure between the PM and no-PM groups.
  
  
  CONCLUSIONS
  The use of PM for hernia repairs in the austere or forward environment appears safe and did not increase the risk of wound infection, mesh infections, or recurrence.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Kuckelman
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA.
authors.forename: Morgan R
authors.initials: MR
authors.lastname: Barron
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Blair
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA. Electronic address: matthew.j.martin16.mil@mail.mil.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
mesh_terms: D000328:Adult; D000346:Afghanistan; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000601:surgery; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007493:Iraq; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods; D008889:Military Personnel / Q000706:statistics & numerical data; D061214:Patient Safety; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013526:Surgical Mesh / Q000009:adverse effects / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Hernia repair; Humanitarian surgery; Military medicine; Prosthetic mesh