These two case reports describe the salvage of infected permanent abdominal wall mesh using calcium sulphate antibiotic beads (STIMULAN) as a carrier material for gentamicin and vancomycin, negative pressure wound therapy (NPWT) and systemic antibiotics.
Case One reports a 38-year-old patient who presented with a painful incisional hernia in the right hypochondrium. Treatment involved the surgical implantation of a midweight polypropylene mesh (Ventralite® C.R. Bard Inc., Murray Hill, NJ). Fourteen days after surgery the patient presented to the emergency department with nausia, fever and vomiting and worsening right hypochondrium pain. The wound was opened in the OR and 400ml of pus was drained and the mesh was visible. Treatment included extensive lavage and NPWT. At subsequent dressing change, STIMULAN beads were prepared with gentamicin and placed along the base of the wound, including the exposed mesh. The beads were covered with a layer of Adaptic™ (Systagenix, Gatwick, UK). After discharge, home care nurses provided dressing changes 3 times per week. At 6 weeks the wound had healed and STIMULAN Beads were not visible. The wound remained healed and the hernia repair was intact at 1-year follow-up.
Case Two reports a 60-year-old patient presented with a midline incisional hernia of 7 cm width following a Nissen fundoplication. The patient suffered various complications and at 6 months there was no major improvement, so the possibility of salvaging the mesh was offered. In the operating room, unincorporated mesh was excised, skin flaps and rectus muscle was circumferentially raised, and the incorporated mesh was approximated with interrupted 2−0 polypropylene sutures (Prolene®, Ethicon Inc, Bridgewater, NJ). STIMULAN beads prepared with vancomycin and gentamicin were placed in the wound over top of the mesh closure, and the skin closed. At 3 months follow-up the wound had achieved complete epithelialization with no evidence of infection or hernia recurrence. The patient remained free of infection and the hernia repair intact on 9-month follow-up.
The abstract and full paper can be obtained here.