Annals of Thoracic Surgery 2013-03-01

Chest wall reconstruction using biomaterials.

Daniel L Miller, Seth D Force, Allan Pickens, Felix G Fernandez, Theresa Luu, Kamal A Mansour

Index: Ann. Thorac. Surg. 95(3) , 1050-6, (2013)

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Abstract

Skeletal chest wall reconstruction can be a challenge, depending on the indication, location, and health of the patient; various materials are available. Recently, biomaterials that are remodelable (bovine pericardium patch; Veritas, Synovis Life Technologies Inc, St Paul, MN) or absorbable (polylactic acid [PLA] bar; BioBridge, Acute Innovations, Hillsboro, OR) have been introduced for reconstruction procedures.We performed a retrospective review of all patients who underwent chest wall stabilization or reconstruction between July 1, 2009, and March 31, 2011.Biomaterials were used in 25 of 112 patients (22%) who underwent chest wall stabilization or reconstruction, and they form the basis of this review. Indication for reconstruction was malignant disease in 17 patients (68%). Overall, 10 (40%) resection sites were infected preoperatively. Reconstruction was performed with a combination of bovine pericardium and PLA bars in 11 patients (44%), bovine pericardium alone in 10, and PLA bars alone in 4; muscle flaps were interposed in 7 patients (28%). There were no operative deaths. Complications occurred in 6 patients (24%). Median follow-up was 12 months (range, 6 to 27 months). Three patients required removal of their biomaterials. Two bovine pericardial patches were removed prophylactically at the time of debridement of a partially necrotic muscle flap, and 1 PLA bar was removed because of an inflammatory reaction. None of the patients with an infected resection site required removal of their biomaterial.Chest wall reconstruction with biomaterials is a valuable option in the management of patients with chest wall abnormalities. Early results are promising. Biomaterials may be the preferred method of reconstruction for infected chest wall sites.Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.