, Volume 16, Issue 4, pp 475–479 | Cite as

Salvage of an infected titanium mesh in a large incisional ventral hernia using medicinal honey and vacuum-assisted closure: a case report and literature review

  • G. ChatzoulisEmail author
  • K. Chatzoulis
  • P. Spyridopoulos
  • P. Pappas
  • A. Ploumis
Case Report


The overall reported percentage of mesh infections is 1.3%. Infections after incisional ventral hernia repair depend on many factors. Salvaging an infected mesh should be the priority, because serious complications are reported following mesh removal. In this case report, a methicillin-resistant Staphylococcus aureus (MRSA)-infected titanium mesh was salvaged by a novel technique, not requiring removal. The combination of vacuum-assisted closure (VAC™ therapy) of the wound and medical honey (L-Mesitran™) proved to be successful in leaving the mesh in situ. We report the successful management of this infected titanium mesh and review the literature regarding the possible pathogenetic mechanisms and treatment options.


Hernia repair Infection MRSA Prosthetic mesh Honey 


  1. 1.
    Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 93(1):5–10PubMedCrossRefGoogle Scholar
  2. 2.
    Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B et al (2010) Hernia repair: the search for ideal meshes. Hernia 14:81–87PubMedCrossRefGoogle Scholar
  3. 3.
    Stremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M et al (2010) Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 34:1702–1709PubMedCrossRefGoogle Scholar
  4. 4.
    Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege RV et al (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg 24:95–101PubMedCrossRefGoogle Scholar
  5. 5.
    Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441PubMedGoogle Scholar
  6. 6.
    Itani KM, Hur K, Kim LT, Anthony T, Berger DH, Reda D et al (2010) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 145(4):322–328PubMedCrossRefGoogle Scholar
  7. 7.
    Schreinemacher MH, Emans PJ, Gijbels MJ, Greve JW, Beets GL, Bouvy ND (2009) Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model. Br J Surg 96(3):305–313PubMedCrossRefGoogle Scholar
  8. 8.
    Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–382PubMedCrossRefGoogle Scholar
  9. 9.
    Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V (2002) Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 63(6):765–771PubMedCrossRefGoogle Scholar
  10. 10.
    Bellón JM, G-Honduvilla N, Jurado F, G-Carranza A, Buján J (2001) In vitro interaction of bacteria with polypropylene/ePTFE prostheses. Biomaterials 22(14):2021–2024PubMedCrossRefGoogle Scholar
  11. 11.
    Bachman S, Ramshaw B (2008) Prosthetic material in ventral hernia repair: how do I choose? Surg Clin North Am 88(1):101–112PubMedCrossRefGoogle Scholar
  12. 12.
    Junge K, Rosch R, Klinge U, Saklak M, Klosterhalfen B, Peiper C et al (2005) Titanium coating of a polypropylene mesh for hernia repair: effect on biocompatibility. Hernia 9(2):115–119PubMedCrossRefGoogle Scholar
  13. 13.
    Carbonell AM, Matthews BD, Dréau D, Foster M, Austin CE, Kercher KW et al (2005) The susceptibility of prosthetic biomaterials to infection. Surg Endosc 19(3):430–435PubMedCrossRefGoogle Scholar
  14. 14.
    Parra JA, Revuelta S, Gallego T, Bueno J, Berrio JI, Fariñas MC (2004) Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT. Br J Radiol 77:261–265PubMedCrossRefGoogle Scholar
  15. 15.
    Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Carel Goslings J (2009) Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg 33(2):199–207PubMedCrossRefGoogle Scholar
  16. 16.
    Leininger BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C (2006) Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq. J Trauma 61(5):1207–1211PubMedCrossRefGoogle Scholar
  17. 17.
    Gregor S, Maegele M, Sauerland S, Krahn JF, Peinemann F, Lange S (2008) Negative pressure wound therapy: a vacuum of evidence? Arch Surg 143(2):189–196PubMedCrossRefGoogle Scholar
  18. 18.
    Braakenburg A, Obdeijn MC, Feitz R, van Rooij IA, van Griethuysen AJ, Klinkenbijl JH (2006) The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg 118(2):390–397PubMedCrossRefGoogle Scholar
  19. 19.
    Tolino MJ, Tripoloni DE, Ratto R, García MI (2009) Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results. Hernia 13:631–637PubMedCrossRefGoogle Scholar
  20. 20.
    Postmes T, van den Bogaard AE, Hazen M (1993) Honey for wounds, ulcers, and skin graft preservation. Lancet 341(8847):756–757PubMedCrossRefGoogle Scholar
  21. 21.
    Du Toit DF, Page BJ (2009) An in vitro evaluation of the cell toxicity of honey and silver dressings. J Wound Care 18(9):383–389PubMedGoogle Scholar
  22. 22.
    Postmes T, Vandeputte J (1999) Recombinant growth factors or honey? Burns 25(7):676–678PubMedGoogle Scholar
  23. 23.
    Rosengren H, Dixon A (2010) Antibacterial prophylaxis in dermatologic surgery: an evidence-based review. Am J Clin Dermatol 11(1):35–44PubMedCrossRefGoogle Scholar
  24. 24.
    French VM, Cooper RA, Molan PC (2005) The antibacterial activity of honey against coagulase-negative staphylococci. J Antimicrob Chemother 56:228–231PubMedCrossRefGoogle Scholar
  25. 25.
    Cooper RA, Jenkins L (2009) A comparison between medical grade honey and table honeys in relation to antimicrobial efficacy. Wounds 21(2):29–36Google Scholar
  26. 26.
    Katsikogianni M, Missirlis YF (2004) Concise review of mechanisms of bacterial adhesion to biomaterials and of techniques used in estimating bacteria–material interactions. Eur Cell Mater 8:37–57PubMedGoogle Scholar
  27. 27.
    Coda A, Botto Micca F, Bossotti M, Manfredi S, Mattio M, Ramellini G et al (1998) Reoperations for chronic infections following prosthetic hernia repair. Hernia 2(4):163–167CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • G. Chatzoulis
    • 1
    Email author
  • K. Chatzoulis
    • 1
  • P. Spyridopoulos
    • 1
  • P. Pappas
    • 1
  • A. Ploumis
    • 2
  1. 1.First Department of Surgery424 General Military HospitalThessalonikiGreece
  2. 2.Department of Orthopaedics and RehabilitationUniversity of IoanninaIoanninaGreece

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