Contemporary approaches to complex and contaminated hernias: innovations in mesh technology

Ventral hernia repair in contaminated fields remains challenging, with evolving mesh technologies reshaping surgical approaches. While biologic mesh was traditionally preferred, recent evidence supports the use of permanent synthetic mesh in Centers for Disease Control (CDC) Class I-III wounds, showing lower recurrence rates and similar infection risks. Biosynthetic meshes, such as Phasix<sup>TM</sup>, provide reliable long-term durability and offer a cost-effective alternative to biologics, with promising infection resistance. A novel mesh suture (Duramesh<sup>TM</sup>) improves fascial closure by distributing tension and integrating with tissue, showing early success in contaminated settings. This review outlines an approach to complex and contaminated hernias that incorporates these new technologies and discusses considerations for staged reconstruction. Permanent synthetic mesh remains the most reliable way to reduce hernia recurrence, while biosynthetic and mesh-suture technologies serve as valuable adjuncts for non-definitive repairs. Further research on the long-term safety and efficacy of biosynthetic meshes and mesh sutures is required to establish consensus in contaminated hernia repair.