From the Guidelines
Vicryl (polyglactin 910) mesh is not recommended for use in contaminated surgical fields due to its high risk of infection and subsequent complications. In contaminated settings, the use of Vicryl mesh can lead to mesh failure, abscess formation, and wound complications, as the polyglactin 910 material can serve as a nidus for bacterial colonization 1. The 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias suggests that biological meshes may be used for repair in contaminated fields, but only when a biological mesh is available and the defect size is large 1.
When considering mesh reinforcement in a contaminated field, the following options are preferred:
- Biological meshes, such as acellular dermal matrices, which become vascularized and remodeled into autologous tissue after implantation, offering a low-morbidity alternative to prosthetic mesh products in complex settings 1
- Specially designed synthetic meshes with antimicrobial properties
- Delayed mesh placement after the contamination has been controlled, which may involve leaving the wound open initially and then placing the mesh once the infection is under control
The use of Vicryl mesh in contaminated fields is associated with high infection rates, as reported in several studies, including a retrospective study by Kelly and Behrman, which found a 21% infection rate in emergency and elective incisional hernia repairs 1. In contrast, biological meshes have been shown to have lower infection rates and better outcomes in contaminated fields, as demonstrated in a prospective study by Catena et al., which found that incisional hernioplasty using porcine dermal collagen grafts was a safe and efficient approach to difficult contaminated cases 1.
In summary, the use of Vicryl mesh in contaminated surgical fields is not recommended due to its high risk of infection and complications, and alternative options such as biological meshes or delayed mesh placement should be considered instead.
From the Research
Safety of Vicryl Mesh in Contaminated Surgical Fields
- The use of Vicryl (polyglactin 910) mesh in contaminated surgical fields has been evaluated in several studies 2, 3, 4, 5, 6.
- A study published in 2007 found that the use of Vicryl Plus, a antimicrobial suture, reduced the infection rate in surgical sites compared to traditional Vicryl suture 2.
- Another study published in 1997 reported the use of Vicryl Collagen as a dura substitute in 78 neurosurgical procedures, with minimal complications and no major infections related to the mesh 3.
- A study published in 2013 evaluated the outcomes of synthetic mesh in contaminated ventral hernia repairs and found favorable infection, recurrence, and mesh removal rates 4.
- A systematic review and meta-analysis published in 2023 evaluated the postoperative outcomes of biosynthetic meshes in contaminated fields and found a significant higher recurrence rate in long-term follow-up compared to short-term follow-up 5.
- A randomized controlled trial published in 2009 compared the efficacy of antimicrobial coating suture coated polyglactin 910 with tricosan (Vicryl Plus) to polyglactin 910 (Vicryl) in reducing surgical site infection in appendicitis and found no statistical difference between the two groups 6.
Key Findings
- The use of Vicryl mesh in contaminated surgical fields may be associated with a reduced risk of surgical site infection 2, 4.
- Biosynthetic meshes, such as Vicryl, may be a viable option for hernia repair in contaminated fields 5.
- Antimicrobial coating suture coated polyglactin 910 with tricosan (Vicryl Plus) may be safe and effective in reducing surgical site infection 2, 6.