title: A rigid and bioabsorbable material for anterior chest wall reconstruction in a canine model.
abstract: OBJECTIVE
  The optimal material for anterior chest wall reconstruction following chest wall resection remains controversial. The aim of this experimental study was to evaluate short-term, morphological and histological outcomes of anterior chest wall reconstruction with a rigid and bioabsorbable material in a canine model.
  
  
  METHODS
  Twenty adult beagle dogs underwent anterior chest wall resection. In the experimental group (n = 10), the anterior chest wall was reconstructed with a rigid and bioabsorbable material composed of poly-L-lactide acid matrix (60 wt%) and uncalcined and unsintered hydroxyapatite particles (40 wt%), whereas in the control group it was (n = 10) reconstructed with dual polypropylene mesh sheets. Short-term complication rates were compared with a χ(2) test. Postoperative sternal deviations were evaluated with sternal alignment angles using computed tomography and multiplanar reconstruction and were compared with Mann-Whitney U-test immediately after reconstruction, and at 1, 3, 6, 9 and 12 months postoperatively. Histological findings of the regenerated chest wall tissue were obtained after staining with haematoxylin and eosin and Elastica van Gieson (EVG) and compared at 3, 6, 9 and 12 months.
  
  
  RESULTS
  There was not a significant difference in the short-term postoperative complication rate (P = 0.53) and the complication rate was 20% (wound infection, n = 1 and lethal mediastinitis, n = 1) in the control group and 10% (wound infection, n = 1) in the experimental group. The postoperative sternal deviation was significantly less remarkable at 1 month (123.3 ± 32.2° vs 159.4 ± 19.7°, P = 0.027), 3 months (109.8 ± 34.7° vs 150.9 ± 34.2°, P = 0.039) and 12 months (61 ± 15.6° vs 170.3 ± 6.6°, P = 0.046) in the experimental group than in the control group, whereas no significant difference was noted immediately after reconstruction (165.7 ± 6.4° vs 168.4 ± 9.1°, P = 0.50). Histological findings showed dense connective tissue in the regenerated chest wall in both groups and showed chondroblasts in the regenerated chest wall tissue at 3 and 6 months only in the experimental group.
  
  
  CONCLUSIONS
  Our results suggest that anterior chest wall reconstruction with a rigid and bioabsorbable material is feasible and may be a valuable alternative to reconstruction with a non-rigid and non-absorbable material.
authors.affiliation: Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan mhamaji@kuhp.kyoto-u.ac.jp.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hamaji
authors.affiliation: Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Fumitsugu
authors.initials: F
authors.lastname: Kojima
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Koyasu
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nobashi
authors.affiliation: Center for Anatomical, Pathological and Forensic Medical Researches, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Tsuruyama
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.affiliation: Department of Bioartificial Organs, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D011091:Polyesters; D011126:Polypropylenes; D011474:Prosthesis Design; D013524:Surgical Flaps; D013526:Surgical Mesh; D035441:Thoracic Wall / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D011091:Polyesters; D011126:Polypropylenes; C033616:poly(lactide)
keywords: Chest wall; Prosthesis; Sternum