Management of infections of polytetrafluoroethylene-based mesh

Abstract

Background: Mandatory removal of infected expanded polytetrafluoroethylene (ePTFE) mesh has been advocated, leading to a high rate of hernia recurrence. Although salvage of infected mesh has been reported, the feasibility, efficacy, and long-term outcomes of this practice remain unclear. The purpose of this study was to delineate a protocol for salvaging infected ePTFE mesh.

Methods: We reviewed retrospectively the records of patients with infections of ePTFE-based mesh placed for complex abdominal hernias at a tertiary referral center from October 1997 to September 2005.

Results: Twenty-two patients were treated for ePTFE-based mesh infections. Fifteen patients had undergone laparoscopic repair, and seven patients had undergone open repair. The median time of presentation after repair was 70 days (range 10-480 days). Fourteen patients had an extensive mesh infection and underwent mesh excision, with twelve patients having attempted fascial closure; hernias recurred in all twelve patients. Two patients underwent mesh excision and repair with a biologic mesh. Eight patients had a limited area of mesh involvement; six of these patients underwent surgical debridement, partial excision of the mesh, re-approximation of the remaining mesh with non-absorbable suture and drains, and application of a vacuum-assisted closure system to the open portion of the wound. These patients received four weeks of antibiotics with delayed wound closure. Two patients underwent percutaneous drainage of a perigraft abscess. There was no hernia recurrence in seven patients with a mean follow-up of approximately three years.

Conclusions: Infections of ePTFE-based mesh can present in early or delayed fashion. Although mesh with extensive infection could not be salvaged, limited mesh infections could be managed successfully with percutaneous or open drainage and prolonged antibiotic courses.