RECONSTRUCTIVE SURGERY OF THE ABDOMINAL WALL WITH TITANIZED PP MESH IN A CASE OF CHRONIC INFECTION OF ePTFE MESH

Background The use of meshes in abdominal wall reconstructive surgery is common and globally considered the gold standard. Materials like expanded polytetrafluoroethylene (ePTFE) meshes or "Gore-Tex®", once popular, have been shown to pose higher risks of rejection and infection compared to polypropylene (PP) meshes. Methods In the case of a 59-year-old man with a history of costal chondrosarcoma that required resection of the 10th left rib in 2009, a Gore-Tex® mesh was used in abdominal wall reconstruction in 2009. He was referred to our center in 2021 due to mesh intolerance. Explorations (thoraco-abdominal CT and PET-CT) revealed chronic mesh infection with a bacterial biofilm (collection of 20 × 4 × 7 cm (AP × T × CC) encompassing the prosthesis), associating a fistulous tract to the skin surface. Multi-resistant Staphylococcus was isolated, requiring 6 weeks of antibiotic treatment with dalbavancin and rifampicin. Results Surgical intervention involved block resection of the collection and fistulous tract, and repair using titanized-PP mesh. After 48 hours of uneventful postoperative course, he was discharged with a home hospitalization regimen of antibiotic therapy with IV Ceftriaxone+Daptomycin. No other microorganisms were isolated in surgical cultures, and the pathology result described a granulomatous reaction to a foreign body. At one-year follow-up, the patient remains asymptomatic, with explorations (CT, PET-CT) ruling out recurrence of infection. Conclusions PP meshes are recommended for abdominal reconstructive surgery due to their lower infection and rejection rates compared to ePTFE meshes, due to their macroporous characteristics. However, further research and multidisciplinary management are needed to understand long-term outcomes.