Immediate, Multistaged Approach to Infected Synthetic Mesh

Abstract

Infection of synthetic mesh after abdominal wall hernia repair is a complex problem. The purpose of this study was to determine whether a staged approach to abdominal wall reconstruction (AWR) using a porcine acellular dermal matrix (PADM) is beneficial in the setting of infected synthetic mesh. The authors performed a retrospective review of 27 patients who underwent immediate, staged complex AWR using PADM from 2007 to 2012. After a component separation, primary fascial closure was achieved in 21/27 (78%) patients, whereas 6/22 (22%) received a bridged hernia repair with PADM. Wound-related complications developed in 7/27 (26%) patients including wound dehiscence 6/27 (22%), surgical site infection 5/27 (19%), and hematoma 1/27 (4%). The hernia recurrence rate observed by 32 months was 19%. A bridged hernia repair and the development of a postoperative infection were associated with hernia recurrence, P<0.05. A 2-stage approach to AWR with PADM can provide a safe and effective solution for patients with infected synthetic mesh.