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Atypical graft infection presenting as a remote draining sinus
Deborah Karp1, Costas Apostolis, Roger Lefevre
1From the Cleveland Clinic Florida, Urogynecology and Pelvic Reconstructive Surgery, Weston, Florida; and the Winthrop University Hospital, Department of Obstetrics and Gynecology, Mineola, New York.
Obstetrics and Gynecology
|July 23, 2009
Summary
A rare infection occurred in a woman 18 months after pelvic reconstructive surgery using synthetic mesh. The infection formed a draining sinus tract to her leg, successfully treated with antibiotics and surgery.
Area of Science:
- Urogynecology
- Surgical Innovation
- Infectious Disease
Background:
- Synthetic mesh, particularly multifilament polypropylene, is increasingly used in pelvic reconstructive surgery.
- This material has been linked to healing issues and postoperative complications.
- Intravaginal slingplasty is a surgical procedure for pelvic organ prolapse.
Observation:
- A 75-year-old woman developed recurrent leg cellulitis 18 months post-surgery.
- She had undergone posterior intravaginal slingplasty for vaginal vault prolapse.
- A 35-cm fistulous tract was found, draining from the pelvis to the lower thigh.
Findings:
- The case presents an atypical infection secondary to synthetic mesh use.
- The infection manifested as a draining sinus tract extending to the lower extremity.
- Surgical debridement and 12 weeks of intravenous antibiotics led to complete healing.
Implications:
- This case highlights potential complications of multifilament mesh in pelvic surgery, including infection.
- It underscores the importance of recognizing unusual presentations of mesh-related infections.
- Further research may be needed to optimize synthetic mesh safety and patient outcomes.
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