Necrotizing surgical site infection after tension-free vaginal tape

Abstract

Background: Infectious morbidity after tension-free vaginal tape (TVT) treatment of urinary stress incontinence may be a potential concern.

Case: A 53-year-old obese woman with a 7-year history of urinary incontinence consented to TVT placement. Two days after discharge the patient presented with suspected cellulitis. Dicloxacillin, ciprofloxacin, ampicillin/sulbactam, and metronidazole were ineffective. Removal of the tape, surgical debridement, dressing changes, ceftriaxone, and clindamycin followed by levofloxacin and metronidazole, repeat wound debridement, and vacuum assisted closure were required. Frozen section revealed gangrenous soft tissue with areas of skin necrosis, but no fasciitis.

Conclusion: This is the first case of necrotizing surgical site infection after TVT placement. Infectious morbidity risks need to be considered in these procedures.