BEYOND REPAIR A new study examines when you can salvage infected mesh.

Not only are mesh infections common after ventral hernia repairs, but they often take more than a year to develop and they're likely to be unsalvageable.

Those are among the key findings of a study presented by Vedra A. Augenstein, MD, at the 2015 Clinical Congress of the American College of Surgeons. They're based on 161 infected patients who were referred to the Carolinas Medical Center in Charlotte, N.C., over a 10-year period. The study now encompasses more than 200 patients, says Dr. Augenstein, and she will be soon submit an abstract to the European Hernia Society.

The Carolinas team has tried to salvage all cases — using combinations of antibiotics, vacuum-assisted closure and/or debridement and percutaneous drainage — but has succeeded only with MRSA-free non-smokers who had lightweight polypropylene implants and no fistulas. "About 25% of those patients are maintained on antibiotic suppression, however," says Dr. Augenstein. "And lightweight mesh has been associated with a higher recurrence rate."

Overall, the salvage rate has been about 10%, including 33% for patients with lightweight polypropylene and 8% for polytetrafluoroethylene. Patients with Composix, polyester, or heavyweight polypropylene meshes, or who continued to smoke after their infections were diagnosed, have been unsalvageable

Though It's often assumed that mesh patients are out of danger after a year, "it took a very long time for some of these infections to present," says Dr. Augenstein. "This was a big surprise for us." Also, she says, re-infections are common even when salvage seems to work, so "we need to follow these patients for a very, very long time."

She recommends working with infectious disease specialists, tracking C-reactive protein and erythrocyte sedimentation rate for at least a year after surgery to make sure patients "are not brewing an infection."

Jim Burger