Synthetic Mesh versus Acellular Dermal Matrix for Oncologic Chest Wall Reconstruction: A Comparative Analysis
Salvatore Giordano, MD, PhD, Patrick B. Garvey, MD, FACS, Mark W. Clemens, MD, FACS, Donald P. Baumann, MD, FACS, Jesse C. Selber, MD, FACS, David C. Rice, MD, FACS, Jun Liu, PhD, Charles E. Butler, MD, FACS.
MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE: Management of chest wall reconstruction (CWR) following oncologic resection is challenging due to the nature if pathology, the radical procedure, and the employment of prosthetic materials required for biomechanical stability. Traditional material for CWR includes synthetic prosthesis (i.e. polypropylene or polytetrafluorethylene). However, biologic meshes might result in less wound complications. The aim of this study was to determine whether acellular dermal matrix (ADM) is associated with a lower incidence of complications following chest wall reconstruction for an oncologic resection defect compared to synthetic mesh.
METHODS: We performed a retrospective study of consecutive patients who underwent complex chest wall reconstruction (CWR) using synthetic mesh (SM) or ADM at a single center. Only defects involving at least one rib resection and reconstructed with both mesh and flaps were included. We therefore excluded flap only or mesh only reconstructions and patients with a follow-up <6 months. Patients’ characteristics, treatment factors and outcomes were prospectively documented. The primary outcome measure for the SM versus ADM groups was surgical site occurrence (SSO). Secondary outcomes were specific wound healing, infective, and medical complications, as well as 90-day mortality and re-operation.
RESULTS: One hundred forty six patients (95 [65.1%] with SM; 51 [34.9%] with ADM) underwent CWR with both mesh and flaps for repair of oncologic resection defect. Mean follow-up was 29.3 months (range, 6-109), mean age was 51.5 years, and mean defect area was 173.8 cm2. SM CWR patients underwent more rib resections (2.7 vs 2.0 ribs, P = 0.006) but similar sternal resections (29.5% vs 23.5%; P = 0.591) than ADM CWR patients. SM CWR patients experienced a significantly higher SSO (32.6% vs 15.7%, P = 0.027) than ADM CWR patients. The 2 groups had similar rates of specific wound healing complications. No differences in 90-day mortality, nor re-operations were observed. Multivariable analysis identified prolonged hospital stay, comorbidity, prolonged operative time, and synthetic repairs to be predictive factors of SSO.
CONCLUSION: ADM CWR results in less SSO than SM CWR, when combined with soft tissue flap coverage. Surgeons should consider selectively employing ADM for CWR in patients at higher wound healing risk of complications.
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