A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

• Synergistic gangrene is generated from bacterial colonies present in necrotic tissues. Within our case, continual removal of the necrotic burden was essential in wound bed preparation, reducing contamination and tissue destruction.
• In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh with a detailed surgical follow up is recommended.
• This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair.
• Our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with chronic lymphoblastic leukaemia.

IntroductionWe present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia.Presentation of caseOur patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required. High dose intravenous broad-spectrum antibiotic treatment and Negative Pressure Wound Therapy (NPWT) was administrated in combination with adopting a multidisciplinary approach was key to our success.DiscussionStoppa Re et al. complied a series of 360 ventral hernia mesh repairs reporting an infection rate of 12% that were managed conservatively. However, our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with CLL. Recent modifications in mesh morphology, such as lower density, wide pores, and lighter weight has led to considerable improvements regarding infection avoidance.ConclusionThis case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair.