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Mesh salvage following deep surgical site infection

BACKGROUND: Following herniorrhaphy, deep surgical site infections with mesh involvement (dSSI-MI) traditionally necessitate mesh removal, putting patients at risk for hernia recurrence. There is no consensus about managing infected mesh, as salvage strategies are poorly reported. We describe our outcomes following dSSI-MI at two high-volume hernia centers. MATERIALS AND METHODS: A retrospective review of hernia repairs complicated by dSSI-MI with subsequent salvage attempt was undertaken. Outcome measures included duration of antibiotic use, recurrent dSSI-MI, need for mesh excision, postoperative complications, and hernia recurrence. RESULTS: Thirteen patients underwent attempted mesh salvage (female = 8, median age = 64, and median body mass index = 30.6). 62% had an average of 1.5 prior mesh repairs, and 23% had prior surgical site infection. Twelve underwent open ventral or parastomal hernia repairs, while one patient had a prophylactic mesh augmentation. Three cases required concomitant bowel surgery. Eight dSSI-MIs resulted from gastrointestinal tract complications. All patients received antibiotics for median of 17 days. 92% required operative management of dSSI-MI (100% incision and drainage, 66% debridement of soft tissue). Negative-pressure wound therapy (NPWT) was utilized in 92% for an average of 26 days. One patient was successfully managed without an operation. With a median follow-up of 34 months, there were two recurrent hernias, only one requiring repair. CONCLUSIONS: Despite requiring significant postoperative care (reoperations, prolonged antibiotics, and NPWT), mesh salvage without complete explantation is feasible following dSSI-MI, with a low rate of recurrent hernia formation or long-term infections. Salvage attempts were undertaken primarily in patients with retromuscular macroporous polypropylene, suggesting that repair type and mesh choice influence the decision-making for salvage.