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Recent abdominal wall debridement for infected seroma. Ventrio mesh placed approximately two months ago for large incisional hernia. . Intact and does not appear infected. 13 cm X 7 cm open wound to mesh.
Plan to place a vac today. Would like recommendations of what to place over the mesh.
Thank you.
Dec 9, 2019 by Timothy Harris,
3 replies
Samantha Kuplicki
Hi Timothy, and thank you for your question.

My initial thoughts regarding the information you've provided:
Ventrio mesh is a non-biologic mesh, made of Polypropylene, PDS, and PTFE (part absorbable, part non-absorbable). Given this information, there is no immediate danger of NPWT foam or gauze medium degrading the top polypropylene layer of mesh. In fact, the absence of a contact layer is probably ideal in order to allow for maximum granulation and fibroblastic activity over the mesh's polypropylene woven layers, which should be the side of the mesh exposed if it was placed appropriately. Removing wound exudate from the area will potentially cause a delayed absorption of the absorbable portion of the mesh (may be beneficial). Of note, seroma formation is listed as an adverse reaction to placement of Ventrio Mesh in the package insert.

Is this a bridge repair, inlay, retrorectus, preperitoneal, or IPOM? This will give an idea of what anatomical barriers are present deep to the mesh structure.

Otherwise, biologic meshes are typically more likely to necessitate a contact layer between any foam medium. Keep in mind, these recommendations are likely considered off label or anecdotal, given the cautionary recommendations from NPWT manufacturers regarding exposed structures or implants. Having said that, we utilize this therapy consistently in exposed mesh cases.

This may be an appropriate application for NPWT with instillation with saline to keep inflammatory exudate and infectious materials away from the mesh. This is given the assumption there is no communication with intraabdominal structures. We have utilized this to salvage mesh in specific situations of highly infected abdominal wounds.

Overall, I believe NPWT over no NPWT is beneficial, and further than no contact layer is required.

WoundReference Topic: How to Select and Apply NPWT

Vacuum assisted closure therapy in the treatment of mesh infection after hernia repair. https://www.ncbi.nlm.nih.gov/pubmed/19848066

VAC-instillation therapy in abdominal mesh exposure: a novel indication https://www.ncbi.nlm.nih.gov/pubmed/27884322
Dec 9, 2019
Thank you....great information. Mesh is pre-peritoneal with mesh side up . Felt intact at the time of surgery. I was wondering about the NS installation and you answered that as well. Thanks for your help.
Dec 9, 2019
Samantha Kuplicki
Absolutely, Timothy--Please let us know how it goes, or if you have any other questions. Thanks so much!
Dec 9, 2019
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