RT Journal Article SR Electronic T1 It all doesn’t always have to go: abdominal wall reconstruction involving selective synthetic mesh explantation with biologic mesh salvage JF Canadian Journal of Surgery JO CAN J SURG FD Canadian Medical Association SP E48 OP E51 DO 10.1503/cjs.004422 VO 66 IS 1 A1 Isha Ober A1 Tommy Stuleanu A1 Chad G. Ball A1 Duncan Nickerson A1 Andrew W. Kirkpatrick YR 2023 UL http://canjsurg.ca/content/66/1/E48.abstract AB The comparative performance of synthetic and biologic meshes in complex and contaminated abdominal wall repairs remains controversial. Though biologic meshes are generally favoured in contaminated fields, this practice is based on limited data. Standard dictum regarding infected mesh is to either explant it early or pursue aggressive conservation measures depending on mesh position and composition. Explantation is typically morbid, leaving the patient with recurrent hernias and few reconstructive options. We report a case in which a hernia repaired with synthetic mesh recurred and was reconstructed with underlay biologic mesh. Delayed wound hematoma occurred after initiating anticoagulation for late postoperative pulmonary embolism, which became chronically infected. After multiple failed attempts at medical and interventional salvage of the mesh infection, the patient underwent selective explantation of synthetic mesh with conservation of the underlying biological mesh. She recovered completely without recurrent abdominal wall failure at long-term follow-up. We suggest the “salvageable” characteristics of biologic meshes may allow conservation, rather than explantation, in select cases of infection.