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