Mesh ingrowth with concomitant bacterial infection resulting in inability to explant: a failure of mesh salvage

Removal is the standard treatment for mesh infection following prosthetic hernia repair. However, certain types of mesh may be less amenable to removal even in the setting of active infection; we present four such cases, all involving the same composite mesh. Four high-risk patients underwent Parietex mesh implantation for large ventral wall hernias and developed subsequent Staphylococcus infections with attempted explantation of infected mesh and wound care. There was inability to completely explant mesh in all four cases, leading to chronic purulent wounds and long-term complications. While mesh infection is a recognized complication of prosthetic hernia repair, many synthetic meshes form a slimy biofilm and thus can be removed relatively easily. However, the structural qualities of certain types of mesh create ingrowth into tissues even in the setting of infection, resulting in inability to explant with subsequent long-term chronic wound complications.