Negative Pressure Wound Therapy for Treatment of Mesh Infection After Abdominal Surgery: Long-Term Results and
S Nobaek1, P Rogmark2,3, U Petersson2,3
11 School of Medical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Background And Aims:
Treatment of synthetic mesh infections has previously often resulted in mesh explantation. Negative pressure wound therapy has been used in these situations with encouraging results. The aims of this study were to evaluate wound healing, mesh preservation, and patient-reported outcome after negative pressure wound therapy of mesh infections.
Material And Methods:
Medical records of patients treated with negative pressure wound therapy for mesh infection and age-matched mesh-operated controls without postoperative complications were scrutinized in a retrospective study. An abdominal wall complaints questionnaire was used to evaluate patient-reported outcome.
Results:
Of 722 mesh operations performed 2005-2012, negative pressure wound therapy was used for treating postoperative mesh infections in 48 patients. A total of 48 age-matched controls were recruited from patients without wound complications. No differences were found between groups regarding preoperative characteristics. The following peroperative characteristics were significantly more frequent in the negative pressure wound therapy group: emergency operation, dirty/infected surgical field, surgical techniques other than laparoscopic intraperitoneal onlay mesh repair, implantation of more than one mesh, larger mesh size, longer duration of surgery, and mesh not completely covered with anterior rectus fascia. The entire mesh was salvaged in 92%, while four meshes were partly excised. Wounds healed in 88% after a median of 110 (range 3-649) days. In total, 85% in the negative pressure wound therapy group and 75% in the control group answered the questionnaire. There were no significant differences regarding pain, other abdominal wall symptoms, and satisfaction with the final result in favor of the controls.
Conclusion:
No mesh had to be explanted and wound healing was achieved in the majority of patients when negative pressure wound therapy was used for treatment of mesh infections. However, time to healing was long, and numerous procedures were sometimes needed. Positive long-term outcome was more frequently reported among controls.
Insights
Negative pressure wound therapy (NPWT) successfully treated synthetic mesh infections, preserving the mesh in most cases. While wound healing was achieved, recovery was prolonged, and patient outcomes were comparable to controls.
Area of Science:
- Surgical Innovation
- Wound Management
- Biomaterials
Background:
- Synthetic mesh infections often necessitate mesh removal.
- Negative pressure wound therapy (NPWT) shows promise for treating these complex infections.
- Previous outcomes for mesh infections typically involved explantation.
Purpose of the Study:
- To evaluate wound healing after NPWT for mesh infections.
- To assess mesh preservation rates with NPWT.
- To determine patient-reported outcomes following NPWT for mesh infections.
Main Methods:
- Retrospective study of 48 patients treated with NPWT for mesh infection.
- Comparison with 48 age-matched controls without complications.
- Patient-reported outcomes assessed via an abdominal wall complaints questionnaire.
Main Results:
- Mesh salvage rate was 92% with NPWT; no meshes were fully explanted.
- Wound healing occurred in 88% of NPWT patients, with a median healing time of 110 days.
- No significant differences in pain, symptoms, or satisfaction between NPWT and control groups.
Conclusions:
- NPWT effectively treats synthetic mesh infections, avoiding explantation and promoting wound healing.
- Treatment duration can be lengthy, sometimes requiring multiple procedures.
- Long-term outcomes reported by patients were more favorable in the control group.
