title: A new alternative for bony chest wall reconstruction using biomaterial artificial rib and pleura: animal experiment and clinical application.
abstract: OBJECTIVE
  To evaluate a new method for chest wall reconstruction using porcine-derived artificial rib and pleura in an animal experiment. Further, the clinical application was performed in five patients with large defects in the chest wall as a preliminary observation.
  
  
  METHODS
  In animal experiments, a full-thickness chest wall defect of 7 cm × 8 cm was created in 12 adult mongrel dogs. Six dogs underwent reconstruction with porcine-derived artificial ribs and pleura (test group), and six with methylmethacrylate and double polyester mesh in the form of traditional Marlex sandwich technique (control group). At follow-up of each for 3, 6, and 12 months postoperatively, a general performance assessment and thoracic radiography were performed. Gross and histopathological examinations were carried out following humane euthanasia at the time of last follow-up. In clinical application, five patients with wide tumor resection in the chest wall underwent reconstruction with porcine-derived artificial ribs and pleura as well.
  
  
  RESULTS
  In animal experiment, no perioperative death or hyperpyrexia occurred and no difference in either infection or dyspnea was noted between the two groups. Postoperative radiography revealed good thoracic integrity with no evidence of collapse, deformation, or abnormal movement in the test group. In the control group, similar results were observed, except that two dogs had abnormal movement in the chest wall associated with respiration. Severe adhesions between the 'sandwich' complex and the host tissues were identified in the control group, but by contrast, only mild adhesions were noted in the test group. The non-degradable polyester mesh induced fibrous proliferation and rejection, whereas the artificial pleura was absorbed with mild fibrous hyperplasia after 12 months. In clinical application, no thoracic deformity, chronic pain, or respiratory discomfort were observed at 1 or 12 postoperative months.
  
  
  CONCLUSIONS
  Porcine-derived ribs and pleura can be employed safely to create an artificial chest wall to repair bony chest defects. The clinical results corresponded well with those of animal experiments, and thus confirmed the safety and feasibility of this new alternative of chest wall reconstruction. However, a long-term study in a large number is needed due to the small number of animals in this study.
authors.affiliation: Department of Thoracic Surgery and State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China. zhlanj@mail.sysu.edu.cn
authors.forename: Lan-jun
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Wu-ping
authors.initials: WP
authors.lastname: Wang
authors.forename: Wei-yang
authors.initials: WY
authors.lastname: Li
authors.forename: Chong-li
authors.initials: CL
authors.lastname: Hao
authors.forename: Zhe
authors.initials: Z
authors.lastname: Li
authors.forename: Qiu-liang
authors.initials: QL
authors.lastname: Wu
authors.forename: Rao-pan
authors.initials: RP
authors.lastname: Wu
authors.forename: Tie-hua
authors.initials: TH
authors.lastname: Rong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001672:Biocompatible Materials; D001705:Bioprosthesis; D004195:Disease Models, Animal; D004285:Dogs; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010994:Pleura / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D019736:Prostheses and Implants; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012272:Ribs / Q000473:pathology / Q000601:surgery*; D013526:Surgical Mesh; D013899:Thoracic Neoplasms / Q000601:surgery; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials