Surgical field contamination is a critical concern during abdominal wall prosthetic repair, as it significantly affects the risk of postoperative infections. This review paper combines an extensive analysis of relevant literature with personal experience to explore the challenges and advancements in the placement of mesh in contaminated surgical fields for the management of abdominal wall defects. Historically, the presence of any surgical field contamination was considered a contraindication for prosthetic placement due to the high risk of infection. However, with evolving understanding of the physiology and pathophysiology of biologic reaction around the mesh, as well as the development of various mesh types, the landscape has changed. The emerging understanding of hostmesh interaction, biofilm formation, and local tissue response has contributed to the development of innovative mesh designs that improve outcomes in challenging surgical scenarios. With meticulous surgical technique, adherence to infection prevention protocols, and the appropriate choice of mesh, successful abdominal wall prosthetic repair in contaminated fields is now feasible, opening new possibilities for patients with ventral and incisional hernias.