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A Ventral Hernia-repair-related Mycobacterium mageritense Mesh Infection Treated with NPWT without Mesh Removal
Junji Ando1, Riyo Miyata1, Masayuki Harada1
1Division of Plastic Surgery, Nara Medical University Hospital, Kashihara, Nara, Japan.
Abstract:
Abdominal hernias are often repaired using prosthetic mesh, which is susceptible to infections. Normally, it is necessary to remove the mesh. However, successful mesh salvation with negative-pressure wound therapy (NPWT) has recently been reported. We encountered Mycobacterium(M) mageritense infection after hernia repair using the mesh. M. mageritense is classified as a fast-growing nontuberculous mycobacterium, but few cases have been reported. Nontuberculous mycobacterium can cause rare chronic infections. Skin and soft-tissue infections by nontuberculous mycobacterium involving localized abscess formation and chronic abscesses under various situations have been reported. We report an 85-year-old woman in whom a ventral hernia repair-related M. mageritense mesh infection was treated with NPWT without mesh removal. The hernia was repaired using Bard Ventralex mesh. Pus discharge was seen on the seventh postoperative day, and there was a small area of necrosis under the mesh. From the 13th postoperative day, NPWT was performed for 4 weeks. On the 29th postoperative day, a M. mageritense infection was diagnosed, which was resistant to multiple drugs. After the NPWT, most of the wound showed good granulation tissue formation. In conclusion, the mesh used to repair a hernia became infected with M. mageritense, but NPWT was able to salvage it. In cases of mesh infection involving small necrotic areas, performing NPWT under the guidance of an infectious disease expert may make it possible to preserve the mesh.
Insights
Negative-pressure wound therapy (NPWT) successfully treated a rare Mycobacterium mageritense mesh infection following hernia repair, preserving the prosthetic mesh. This approach offers a potential alternative to mesh removal in select cases.
Area of Science:
- Surgical Innovation
- Infectious Diseases
- Wound Management
Background:
- Abdominal hernia repair frequently utilizes prosthetic mesh, which carries a risk of infection.
- Mesh infections typically necessitate surgical removal, increasing patient morbidity.
- Negative-pressure wound therapy (NPWT) has emerged as a potential method for mesh preservation.
Observation:
- A rare case of Mycobacterium mageritense infection occurred post-ventral hernia repair with prosthetic mesh.
- The patient presented with pus discharge and mesh-related necrosis on postoperative day seven.
- Mycobacterium mageritense is a fast-growing, multidrug-resistant nontuberculous mycobacterium.
Findings:
- NPWT was initiated on postoperative day 13 for four weeks, alongside antibiotic treatment.
- Diagnosis of Mycobacterium mageritense infection was confirmed on postoperative day 29.
- Post-NPWT, the wound exhibited significant granulation tissue formation, indicating successful infection control and mesh salvage.
Implications:
- NPWT can be a viable strategy to salvage prosthetic mesh in cases of rare mycobacterial infections.
- This approach may avoid mesh explantation, reducing surgical complications and recovery time.
- Collaboration with infectious disease specialists is crucial for managing complex mesh infections with NPWT.
