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

1. 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

2. 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.)

3. 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

4. 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

5. 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.

6. Wound widths 4 days after:
thickness: 2 cm.; surface area: 24.5 cm²;
volume: 48.5 cm³

7. Wound widths 10 days after:
thickness: 1.5 cm.; surface area: 20 cm²;
volume: 31.18 cm³

8. Wound widths 14 days after:
thickness: 1.2 cm.; surface area: 18 cm²;
volume: 27.18 cm³
Wound suture was performed

9. Hospital stay was 25 days
Final result 35 days after

10. 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