Hyperbaric oxygen therapy as adjunctive treatment for postoperative cellulitis involving intrapelvic mesh

Placement of intrapelvic mesh has become an integral tool in pelvic reconstructive surgery. Infection is a serious complication of mesh placement, which not only compromises the surgical objective, but also may be disfiguring or potentially lethal. We report a case of serious postoperative cellulitis, where the combination of antibiotics and hyperbaric oxygen contributed to the patient's recovery with complete preservation of her surgical repair. A 45-year-old woman underwent surgery for the treatment of cystocele, rectocele, and stress urinary incontinence. Surgical polypropylene and porcine acellular mesh was placed intraoperatively, and intravenous antibiotics were given preoperatively and postoperatively, followed by a course of oral prophylaxis. On postoperative day 8 the patient reported temperature elevation and a painful swelling in her left buttock. She had an area of cellulitis involving the operative site at the buttock extending anteriorly to the labia majora and posterior to the midgluteal area. Intravenous antibiotics were administered along with hyperbaric oxygen. The patient made an uneventful recovery during the following 9 days, preserving her repair. Cellulitis involving operative sites with artificial or naturally derived materials is a serious complication that may pose a threat to the repair at minimum, and may be life threatening at worst. The case reported illustrates the value of adjunctive hyperbaric therapy where the infection is presumed to be aggressive.