title: In vitro comparison of biological and synthetic materials for skeletal chest wall reconstruction.
abstract: BACKGROUND
  Various biological and synthetic materials have been proposed for use in skeletal chest wall reconstruction (SCWR). Because of the lack of studies allowing a direct comparison of SCWR materials, their clinical use often depends on the surgeon's preference and experience. The aim of this study was to analyze 6 synthetic and 3 biological materials frequently used in SCWR with respect to their cytotoxicity, bacterial adhesion, surface characteristics, and mechanical properties to facilitate data-driven decisions.
  
  
  METHODS
  The effect of the SCWR materials and their extracts on the metabolism of human skeletal muscle cells (SkMCs), dermal fibroblasts, adipose cells, and osteoblasts was analyzed in vitro. Bacterial adhesion was quantified by incubating samples in bacterial suspensions (Staphylococcus epidermidis, S aureus, and Escherichia coli), followed by counting colony-forming units and performing scanning electron microscopy. Moreover, the mechanical properties of the materials were analyzed under uniaxial tensile loading to failure.
  
  
  RESULTS
  The metabolism of all cell types seeded on the SCWR materials was reduced compared with untreated cells. With the exception of Vypro (Ethicon, Somerville, NJ), whose extracts significantly reduced fibroblast viability, no cytotoxic leachable substances were detected. Biological materials were less cytotoxic compared with synthetic ones, but they demonstrated increased bacterial adhesion. Synthetic materials demonstrated higher elongation to failure than did biological materials.
  
  
  CONCLUSIONS
  Biological and synthetic SCWR materials showed significant differences in their cytotoxicity, bacterial adhesion, and biomechanical properties, suggesting that they may be used for different indications in SCWR. Further comparable in vivo studies are needed to analyze their performance in different indications of clinical application.
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Wiegmann
authors.affiliation: Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Korossis
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Burgwitz
authors.affiliation: Orthopedic Clinic, Laboratory for Biomechanics and Kinematics, Hannover Medical School, Hannover, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Hurschler
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fischer
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany; Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany. Electronic address: kuehn.christian@mh-hannover.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Kuehn
mesh_terms: D001422:Bacterial Adhesion; D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D002478:Cells, Cultured; D005347:Fibroblasts; D006801:Humans; D066298:In Vitro Techniques; D008422:Materials Testing; D019616:Thoracic Surgical Procedures / Q000379:methods; D035441:Thoracic Wall / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials