ewma 2013 - ep507 - conservative management of mesh site infection in abdominal incisional hernia...

CONSERVATIVE MANAGEMENT OF MESH SITE INFECTION IN ABDOMINAL INCISIONAL HERNIA REPAIR BY APPLICATION OF TOPICAL NEGATIVE

PRESSURE THERAPY: A CASE REPORT

Marco Negri (MD), S. Bolzon, G.P.Guerrini, F. Zanzi, A.Vagliasindi, E. Guerra, P. Soliani Department of General Surgery (Chairman: P. Soliani) Hospital of Ravenna, Italy

Patient

Female, 68 years old

2008 sigmoidectomy for diverticulitis (open technique)

Comorbidities: cronic gastritis, drugs allergies (ciprofloxacin, ketoprophen)

Large midline abdominal incisional hernia (defect widths 15x5 cm.)

Surgical Procedure:open technique

Abdominal incisional hernia was repaired

by application of flexible composite

polypropylene mesh (25X35 cm.) positioned onlay above the abdominal wall muscles and fascia, behind the subcutaneous fat

30 days after surgical procedure Fever: 39 °C

WBC: 15.50 10^9/L

PCR: 237.6 mg/dl

Seroma

Wound dehiscence

Pus or purulent fluid was sent for culture and sensitivity

Staphilococcus Aureus and Pseudomonas Aeruginosa were found organism causing infection

Patient Treatment

Intravenous antibiotics: amoxicillin-clavulanate, teicoplanin, meropenem

Local wound care for 14 days : topical negative pressure therapy with antibiotic instillation: 240 mg of gentamicin/24 h.

Device: V.A.C. ULTA VeraFlo™ by KCI

Procedure repeated for 3 times/die: Instillation of 80 mg gentamicin/100 cc. followed after 15 min. (time of antibiotic activity) by 8 hours of V.A.C. therapy applied with pressure suction of 125 mmHg.

Wound widths 4 days after: thickness: 2 cm.; surface area: 24.5 cm²;

volume: 48.5 cm³

Wound widths 10 days after: thickness: 1.5 cm.; surface area: 20 cm²;

volume: 31.18 cm³

Wound widths 14 days after: thickness: 1.2 cm.; surface area: 18 cm²;

volume: 27.18 cm³

Wound suture was performed

Hospital stay was 25 days Final result 35 days after

CONCLUSIONS

Mesh hernioplasty is the preferred surgical procedure for abdominal incisional hernia

Infection remains one of the most complications

In some patients the mesh may need removal to overcome infection

Conservative management is likely to be successful by application of Topical Negative Pressure Therapy with local instillation of antibiotic