Prosthetic mesh is often used in hernia repair surgery, with over 20 million such procedures done annually around the world. Mesh is used to augment tissue repair in hernias to reduce tension at the suture line where the “weakness” is strengthened or plugged to hold back internal structures (such as intestine or omentum) that want to bulge through these areas. The mesh can be made of various materials, such as Polypropelene, Gortex, and other plastic materials which allow the body to grow scar tissue around it. The thing remember about prosthetic mesh, is that it is NOT alive or biologically active. Your body recognizes it as a foreign substance, and because of that, there are inherent risks.
For the most part, prosthetic mesh works and does its job; however, when it becomes a problem, it usually becomes a BIG problem. The worst problem of all is when the mesh becomes infected. In that situation, with rare exception, the mesh must be removed–completely. It must be completely removed because any portion that remains may harbor bacteria which the body cannot clear away (even with the most powerful antibiotics), leading to a chronic wound, deeper infection, abscesses, or systemic infection.
The treatment of infected mesh requires a step-wise approach with the first step in removing the mesh and debriding (cleaning) the wound. This step may be repeated multiple times until the area is clean. Once deemed clean, the area that the mesh covered will need to be reconstructed, preferably with your own tissue (flaps), or in combination with a Biologic mesh that can grow with your tissues and that your body ultimately recognizes as “self” tissue. It will take at least 6 weeks from the time of the final reconstruction to fully heal, and depending on the complexity of the wound, infection, and anatomy of the infected mesh, several months in total.
Far too often, I have seen patients who have lived with this problem for too long. A small, chronic wound, may be a sign of a much bigger problem deep down below. Appropriate evaluation, diagnosis, and management is critical, but just as importantly, it is important to first recognize and know that you may have mesh in your body. If it is close to an area that is draining or infected, the mesh must be ruled out as a potential source of the problem. Afterward, it may be necessary to find a team of surgeons, including a general surgeon and plastic surgeon, to work together to solve this difficult problem.