Infected grafts of incisional hernioplasties

Summary

Prosthetic grafts are used often enough for incisional hernioplasty to familiarize surgeons with the management of some complications that are bound to occasionally occur despite correct medical decisions and excellent surgical technique. This paper discusses five cases of infection in grafted incisional hernioplasties. Two are examples of the possibility that exposed and infected grafts can be saved in spite of the loss of a large amount of covering skin, and another when complicated by an intestinal fistula. In a series of 66 incisional hernioplasties performed in the past three years, five wounds developed infections that involved the mesh grafts. Two cases have a higher area of skin loss. All five were successfully treated to complete healing without evidence of residual infection or recurrence of the hernias. The overall success rate for patients followed a year or longer is 95%. Eventual recovery did not guarantee that in the postoperative period additional care was not required, rather it was a time reached when the patient was free of wound problems and an intact repair remained. Treatment of infected mesh repairs require aggressive management including diligent local wound care in all cases, and also, though arguably, systemic antibiotics as well. Equally important is a high degree of patience by the surgeon, the patient and the family for the long time and tedious care needed even to attempt to salvage the grafted repair. These complications are treatment-intensive; they require an unlimited amount of attention and concern by the entire surgical staff to achieve a successful outcome.