Infected mesh salvaging using negative pressure wound therapy with instillation (NPWTi): a case report

Abdominal wall wound dehiscence with mesh exposure is a dangerous adverse event with an incidence of 0.4-1.2% and a mortality rate of up to 25%. To date, there are no standard protocols for the optimal duration of negative pressure wound therapy with instillation (NPWTi) for specific clinical settings and the decision to treat a polypropylene mesh infection with NPWTi has only been made in rare case reports. Moreover, recent studies show contrasting results regarding the reduction of hospital stay for abdominal wall dehiscence with exposed mesh, treated with NPWTi and dwell time or traditional negative pressure wound therapy (NPWT).

A 54-year-old woman with a history of obesity, hypertension, and diabetes underwent surgery for a recurrent post-incisional hernia. Despite the initial plan for a laparoscopic procedure, adhesions necessitated a laparotomy, and a polypropylene mesh was implanted. Postoperatively, complications arose, including a treated subcutaneous fluid collection. However, further subsequent issues emerged, such as fever, wound dehiscence, and mesh exposure. The patient underwent surgical debridement and an attempt to salvage the prosthesis using NPWTi with sodium hypochlorite. After 20 days, inflammatory markers normalized, the wound improved, and the prosthesis did not need to be removed.

Based on our experience, which complements the limited literature currently available, NPWTi may represent an effective treatment option for infected wound dehiscence after abdominal wall prosthetic surgery, in individuals at high risk of complications from prosthesis removal.