In both the right and the left inguinal regions, infectious complications manifested considerably after (not shortly after) the preceding surgical procedure. It therefore remains an open question as to whether the microorganisms responsible were present at the time of surgery, with a delayed presentation, or gained access to the operated fields subsequently, for example by hematogenous spread to the site. We note, however, that the two sides yielded significantly different Z IETD FMK microorganisms by final cultural analysis, which, together with the temporal interval between episodes, suggests that infection on each side derived from a separate source. Suture material as a substrate for clinical biofilm-based

infection has only been described infrequently, with most early reports coming from ocular infections. We have noted previously the role of suture-based biofilm in infections of the abdominal wall in patients who had undergone a gastric bypass surgery (Kathju et al., 2009a, b); in these previous cases, the involved sutures were all multifilament. The present report demonstrates CDK activation that even monofilament suture can become a nidus for postsurgical biofilm infection, and that this can occur in the nonbariatric surgical population. This report is also the first, to our knowledge, to document the growth of a biofilm on implanted xenograft material, and the first to document biofilm

in the aftermath of inguinal herniorrhaphy. ‘Biological meshes,’ composed of organic matrices derived from both human and animal tissue sources, are becoming increasingly common in abdominal wall reconstruction. The material used in this patient is derived from porcine small intestine submucosa, and has been used in patients for diaphragmatic,

perineal, ventral as well as inguinal herniorrhaphy. Reports on its success appear mixed: for example one study examining Surgisis in inguinal hernia repair noted decreased pain on coughing and movement postsurgery compared with polypropylene (Ansaloni et al., 2009). In contrast, another report compared Surgisis with Alloderm (a human acellular dermal graft) in ventral herniorrhaphy, and found postoperative pain and seroma to oxyclozanide be significant problems with Surgisis, with seroma occurring in 13/41 patients, more commonly when a nonperforated formulation of Surgisis was used (Gupta et al., 2006). Our own findings reported here, although occurring after inguinal herniorrhaphy, are more consistent with the latter study, with the cloudy but nonpurulent fluid we observed at surgery qualifying as an infected seroma; this also suggests that a biofilm may form on Surgisis after ventral herniorrhaphy, although direct evidence is lacking. It may also be that biofilms are capable of forming on human allogeneic (as opposed to xenogenic) biological mesh implants after herniorrhaphy – further investigation will be required to address this question.