title: Negative Pressure Wound Therapy for Treatment of Mesh Infection After Abdominal Surgery: Long-Term Results and Patient-Reported Outcome.
abstract: OBJECTIVE
  Treatment of synthetic mesh infections has previously often resulted in mesh explantation. Negative pressure wound therapy has been used in these situations with encouraging results. The aims of this study were to evaluate wound healing, mesh preservation, and patient-reported outcome after negative pressure wound therapy of mesh infections.
  
  
  METHODS
  Medical records of patients treated with negative pressure wound therapy for mesh infection and age-matched mesh-operated controls without postoperative complications were scrutinized in a retrospective study. An abdominal wall complaints questionnaire was used to evaluate patient-reported outcome.
  
  
  RESULTS
  Of 722 mesh operations performed 2005-2012, negative pressure wound therapy was used for treating postoperative mesh infections in 48 patients. A total of 48 age-matched controls were recruited from patients without wound complications. No differences were found between groups regarding preoperative characteristics. The following peroperative characteristics were significantly more frequent in the negative pressure wound therapy group: emergency operation, dirty/infected surgical field, surgical techniques other than laparoscopic intraperitoneal onlay mesh repair, implantation of more than one mesh, larger mesh size, longer duration of surgery, and mesh not completely covered with anterior rectus fascia. The entire mesh was salvaged in 92%, while four meshes were partly excised. Wounds healed in 88% after a median of 110 (range 3-649) days. In total, 85% in the negative pressure wound therapy group and 75% in the control group answered the questionnaire. There were no significant differences regarding pain, other abdominal wall symptoms, and satisfaction with the final result in favor of the controls.
  
  
  CONCLUSIONS
  No mesh had to be explanted and wound healing was achieved in the majority of patients when negative pressure wound therapy was used for treatment of mesh infections. However, time to healing was long, and numerous procedures were sometimes needed. Positive long-term outcome was more frequently reported among controls.
authors.affiliation: 1 School of Medical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Nobaek
authors.affiliation: 2 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.|3 Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Rogmark
authors.affiliation: 2 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.|3 Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Petersson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002176:Candida albicans; D002177:Candidiasis / Q000209:etiology / Q000628:therapy*; D016022:Case-Control Studies; D004927:Escherichia coli Infections / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D059685:Herniorrhaphy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D000071066:Patient Reported Outcome Measures; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy*; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Abdominal surgery; incisional hernia; infection; mesh; negative pressure wound therapy; patient-reported outcome