The challenge of complex wound healing caused by necrotizing fasciitis after infection of tension-free vaginal transobturator tape (TVT-O) incontinence material

Pelvic organ prolapse with or without stress urinary incontinence (SUI) is a common gynecological condition that occurs predominantly in middle and old age. Tension-free vaginal tape (TVT) technique is a surgical procedure for treatment of female SUI that is used worldwide. Severe complications are extremely rare. The authors present treatment methods with which they have successfully used for such cases. The Ljubljana University Medical Center carried out 2,587 TVT operations for genuine SUI between 1998 and 2017. The authors carried out a retrospective study to determine long-term success. However, in all of these years, they treated only two serious complications involving necrotizing fasciitis. Both patients were 61-years old, the first patient suffered necrotizing fasciitis shortly after her transobturator TVT (TVT-O) procedure, and the second six years after the initial surgery. Both of them had had repeated extensive fasciectomy, soft tissue debridement, and various modern wound dressing changes, and one of them had had negative pressure wound therapy. Severe complications of TVT-O are rare but present a possibility for great morbidity and mortality. Early surgical treatment plays an important role, together with additional medication.