--- title: "Case Report: Recurrent Incisional Hernia with Infected Mesh" description: Do you want to see how fasciotens is applied in a surgery? Read the case report for a detailed step-by-step and hear the surgeon's opinion --- [Go Back Up](https://www.fasciotens.com/case-report-hernia-infected-mesh#top) [Skip to Content](https://www.fasciotens.com/case-report-hernia-infected-mesh#body) [![fasciotens home](https://www.fasciotens.com/hs-fs/hubfs/Logos/fasciotens_logo_aws_2020.png?width=200&height=52&name=fasciotens_logo_aws_2020.png "fasciotens home")](https://www.fasciotens.com?hsLang=en) Toggle Menu - [Open Abdomen](https://www.fasciotens.com/abdomen) Toggle children for Open Abdomen Main Menu (Press to Return) \> Open Abdomen - [Discover more](https://www.fasciotens.com/abdomen) - [Publications & Case Reports](https://www.fasciotens.com/case-reports-abdomen) - [E-learning courses](https://academy.fasciotens.com/pages/abdomen) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-abdomen) - [Complex Hernias](https://www.fasciotens.com/hernia) Toggle children for Complex Hernias Main Menu (Press to Return) \> Complex Hernias - [Discover more](https://www.fasciotens.com/hernia) - [Publications & Case Reports](https://www.fasciotens.com/case-reports-hernia) - [E-learning courses](https://academy.fasciotens.com/collections/hernia) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-hernia) - [Congenital Defects](https://www.fasciotens.com/pediatric) Toggle children for Congenital Defects Main Menu (Press to Return) \> Congenital Defects - [Discover more](https://www.fasciotens.com/pediatric) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-pediatric) - [Congresses & Workshops](https://www.fasciotens.com/congresses-workshops) - Services Toggle children for Services Main Menu (Press to Return) \> Services - [E-Learning](https://academy.fasciotens.com) - [Case Discussion](https://www.fasciotens.com/case-discussion) - [Product Feedback & Complaints](https://www.fasciotens.com/product-feedback) - [Downloads](https://www.fasciotens.com/downloads) - [Newsletter](https://www.fasciotens.com/newsletter) - [About us](https://www.fasciotens.com/about-us) - [Local Distribution Partners](https://www.fasciotens.com/contact#distributor) - [Contact](https://www.fasciotens.com/contact) - - [English](https://www.fasciotens.com/case-report-hernia-infected-mesh) - [Deutsch](https://www.fasciotens.com/de/case-report-hernia-infected-mesh) ![Pisa - Luigi Cobuccio Case 1\_photo2](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo2.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo2.jpg) Complex Hernia with Infected Mesh # IFT in a case of multi-recurrent incisional hernia with exposed, infected mesh *Cisanello University Hospital, Pisa, Italy - February 2025* Dr. Luigi Cobuccio reports this case involving a 56-year-old male with a history of multiple failed abdominal wall reconstructions, presenting with exposed mesh, chronic infection, and recurrent hernia. The clinical scenario was further complicated by previous mesh removals, surgical site infection, and a lack of prehabilitation options. Given the challenging surgical field and patient factors, an open approach was planned with the use of intraoperative fascial traction to facilitate direct closure.  ## Case Overview - Patient History - Preoperative Notes - Surgical Procedure - Postoperative Course Patient History A 56-year-old obese man (BMI 36.5), ex-smoker, presented with a complex history of recurrent umbilical incisional hernia and multiple failed repairs performed at other institutions. He had previously undergone umbilical hernia repair with a preperitoneal mesh in 2022, followed by laparoscopic cholecystectomy and suture hernia repair in 2023, which was complicated by small bowel obstruction, re-exploration, and mesh removal. In 2024, he underwent an open Rives-Stoppa repair with polypropylene mesh and anterior component separation (M2M3 W3 defect), followed by a significant postoperative retromuscular hematoma requiring bilateral angioembolization. The course was complicated by surgical site infection and dehiscence, ultimately exposing the mesh.   Preoperative Notes The patient presented with exposed mesh (4 cm diameter), surrounding erythema, and evidence of hernia recurrence (13 cm wide on CT) cranially associated with rectus diastasis. Wound swabs showed Staphylococcus aureus and Corynebacterium simulans. Due to the progressively enlarging exposed mesh and poor compliance, it was decided to proceed with surgical intervention. Prehabilitation was not feasible (no botulinum toxin A or weight loss possible).  Surgical Procedure Surgical exploration revealed significant inflammation and a 15 cm wide residual fascial gap. Complete mesh removal was performed en bloc with erythematous skin. Fasciotens®Hernia was applied to the anterior and posterior rectus sheaths (where present) for 28 minutes to facilitate medialization. This allowed for tension-free midline fascial closure using small-bite PDS 0 sutures. One subcutaneous drain was placed for seroma prevention.  Postoperative Course The patient received cefazolin and metronidazole for 72 hours. The drain was removed on postoperative day 4 and he was discharged on day 5 with good pain control and no complications. Microbiological analysis of the explanted mesh revealed Staphylococcus aureus, Staphylococcus caprae, and Proteus mirabilis. He is under close follow-up, with future plans for a mesh-based reconstruction after adequate prehabilitation in a clean surgical field.  ## Surgical Steps ![Pisa - Luigi Cobuccio Case 1\_photo1](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo1.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo1.jpg) ### Clinical Presentation Initial presentation showing exposed mesh at the umbilicus with surrounding erythema. ![Pisa - Luigi Cobuccio Case 1\_photo2](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo2.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo2.jpg) ### Standing Profile Standing view illustrates the extent of abdominal wall involvement and the hernia bulge. ![Pisa - Luigi Cobuccio Case 1\_photo3](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo3.jpg?width=1179&height=1434&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo3.jpg) ### Pre-operative CT Scan 13.4 cm hernia recurrence with cranial rectus diastasis. ![Pisa - Luigi Cobuccio Case 1\_photo4](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo4.jpg?width=2048&height=1536&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo4.jpg) ### Mesh Explantation Infected mesh removed en bloc with inflamed overlying skin. ![Pisa - Luigi Cobuccio Case 1\_photo5](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo5.jpg?width=1152&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo5.jpg) ### Fascial Defect 15 cm midline gap identified intraoperatively. ![Pisa - Luigi Cobuccio Case 1\_photo6](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo6.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo6.jpg) ### Suture Setup Sutures placed along fascial edges prior to traction. ![Pisa - Luigi Cobuccio Case 1\_photo7](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo7.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo7.jpg) ### Ready for Traction Sutures arranged for attachment to fasciotens®Hernia. ![Pisa - Luigi Cobuccio Case 1\_photo8](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo8.jpg?width=2048&height=1536&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo8.jpg) ### Sutures Secured Traction applied using fasciotens®Hernia system to elongate abdominal wall ![Pisa - Luigi Cobuccio Case 1\_photo9](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo9.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo9.jpg) ### Active Traction Controlled, dynamic vertical traction applied for 28 minutes. ![Pisa - Luigi Cobuccio Case 1\_photo10](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo10.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo10.jpg) ### Direct Fascial Closure Midline successfully re-approximated after IFT. ![Pisa - Luigi Cobuccio Case 1\_photo11](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2025_Pisa%20Infected%20Mesh/Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo11.jpg?width=1536&height=2048&name=Pisa%20-%20Luigi%20Cobuccio%20Case%201_photo11.jpg) ### Final Interoperative View Completed closure of abdominal wall and skin. 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