Conservative treatment of infected mesh by use of gentamycin impregnated calcium sulphate antibiotic beads: a report of two cases

Abstract

Reinforcing an abdominal wall hernia repair with permanent mesh reduces the risk of recurrence [1]. However, mesh infection can occur in up to 5% of implants [2]. This devastating complication may require prolonged hospitalization and systemic antibiotics, repeat interventions to drain sepsis and ultimately mesh explantation. Compared to primary repair, the latter is typically a difficult operation in a hostile abdomen with higher risk of morbidity including bowel injury and subsequent enteric fistulae, bleeding, wound dehiscence and hernia recurrence. Consequently, it is desirable to salvage the mesh by non-operative means. Large studies investigating the optimal method of mesh salvage are lacking and methods to manage mesh infection are mainly derived from case studies. Typically, drainage of the associated infection with prolonged systemic antibiotics are the mainstay, but other therapies such as V.A.C.® (KCI Inc., San Antonio, TX) negative pressure wound therapy (NPWT) [3], medicinal honey [4] and antibiotic irrigation [5] have been described. Stimulan® (Biocomposites Ltd. Staffordshire, England) calcium sulphate antibiotic beads (CSAB) are a biodegradable material that deliver high levels of antibiotics locally to a site of infection and have been described in the salvage of other infected permanent prostheses such as breast implants and vascular grafts [6, 7]. We present a unique approach to salvage of infected permanent abdominal wall mesh using gentamicin impregnated CSAB in conjunction with NPWT and systemic antibiotics. In both cases, the patients gave informed consent for the off label use of CSAB in this setting and consented to the use of their information as part of a case report. Neither author has financial interest in CSAB or other conflict of interests to report. Case report 1