Introduction Emergency ventral hernia repair in complex patients poses challenges, particularly when mesh is used. We report a case of infected mesh repair in a 41-year-old obese lady with a past surgical history of laparotomy for a ruptured infected pancreatic pseudocyst, highlighting the management of mesh infection and controversies surrounding mesh use in acute surgery. This literature review explores mesh infection management and guidelines for mesh use. Methods The patient underwent urgent laparotomy and onlay mesh repair with drains for a tender incarcerated ventral hernia and small bowel obstruction. She self-discharged with drains against medical advice and presented with wound infection 7 days post-discharge, leading to mesh infection. The wound was managed with VAC therapy and IV antibiotics. Results Despite mesh infection, the mesh was salvaged with VAC therapy, gentamicin irrigation, and prolonged antibiotics. The wound healed fully at 3 months follow-up. Evidence suggests VAC therapy can be effective in managing mesh infections, with mesh salvage possible in selected cases [1-3]. The initial clean field became contaminated due to premature drain removal and self-discharge. Conclusion This case highlights the complexity of managing infected mesh when contamination occurs post-operatively. Mesh salvage with VAC therapy and antibiotics can be successful in selected patients. Individualised care and multidisciplinary discussion are crucial. Mesh use in clean fields remains a viable option in emergency hernia repair, with emphasis on post-operative care and follow-up. References: 1. Bardari F, et al. (2018). Management of infected mesh in ventral hernia repair: A systematic review. _Hernia_, 22(3), 349-356. 2. Sogaard K, et al. (2020). Salvage of infected mesh in abdominal wall reconstruction: A systematic review. _J Surg Res_, 245, 115-122. 3. Kockerling F, et al. (2019). Mesh infection and explantation: A review of the literature. _Front Surg_, 6, 34.