Page 321 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Introduction
Recurrence is the most important complication of abdominal wall reconstruction. In order to reduce recurrence rates meshes are used as reinforcement of augmentation or bridging of large abdominal wall defects. Numerous meshes are available worldwide, di ering in material, pore size, weight, tensile strength, elasticity and biocompatibility. These characteristics in uence the risk of failure of repair. Swelling or bulge in the area of previous abdominal wall reconstruction is suggestive for recurrence, although not obligatory to be so(1, 2). It is possible that the repair is still intact and bulging of the mesh causes swelling. Bulging can be the result of an insu cient surgical technique. The problem is more frequently seen after repair of large defects(1), especially when mesh are used to bridge the defects(1, 3) and more frequent after laparoscopic repair(2-4). In this article we present the phenomenon of symptomatic bulging due to failure of a polyester mesh.
Time-line
2004 necrotizing fasciitis
2005-2008 4-staged repair of abdominal wall with polyester mesh
2012 symptomatic bulging of repair due to enlargement of the mesh. Excision part of mesh.
2015 recurrent symptomatic bulging of the mesh. Excision polyester mesh and replacement by polypropylene mesh
Case
A 43-year-old male was referred to the outpatient clinic with severe bulging of the complete right hemi abdomen. One year before he developed necrotizing fasciitis, extending from the right knee to the right thoracic wall resulted in a resection of the right abdominal wall. The patient was left with multiple scars from the right upper leg to the right thorax consisting mainly skin grafts. The abdominal wall consisted skin grafts and peritoneum. The patient experienced reduced quality of life and discomfort. A four-staged repair over three years
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Mesh expansion
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