title: Chest Wall Reconstruction: Evolution Over a Decade and Experience With a Novel Technique for Complex Defects.
abstract: BACKGROUND
  Chest wall reconstruction (CWR) with biologic matrices has gained popularity over the last decade; however, data on this topic remain sparse. The aim of this study is to review the different methods and materials used for CWR while reviewing and highlighting a novel approach using a biologic inlay and synthetic onlay technique for larger, complex high-risk defects.
  
  
  METHODS
  A retrospective review was performed of all patients who underwent full thickness chest wall resection and reconstruction during a 10-year period. Patient characteristics, comorbidities, operative data, as well as postoperative wound complications and outcomes were reviewed. Different reconstructive methods and materials were reviewed and compared.
  
  
  RESULTS
  From December 2003 to January 2014, a total of 81 patients underwent CWR. The indications for resection/reconstruction included oncologic in 49 patients (60.5%), desmoids tumors in 10 (12.3%), bronchopleural fistula in 3 (3.7%), infection in 7 (8.6%), and anatomic deformity in 7 (8.6%) patients. Synthetic and/or acellular dermal matrices (ADM) reconstruction was used in 59 patients (10 biologic, 22 synthetic, and 27 biologic ADM inlay/synthetic onlay combination). On average, 2.5, 3.5, and 3.6 ribs were resected in the biologic, synthetic, and combination group, respectively (P = 0.1). A greater number of patients in the combination group had a history of chemotherapy and/or radiation therapy (P = 0.03) than the synthetic or biologic alone groups. Risk analysis demonstrated an association between the number of ribs resected and postoperative chest wall complications. The incidence of chest wall/wound complications in the synthetic, combination, and biologic groups was 31.8%, 22.2%, and 10%, respectively (P = 0.47).
  
  
  CONCLUSIONS
  In the largest single institution study comparing the use of different reconstructive materials, including ADM in CWR, the authors demonstrate that a biologic inlay/synthetic onlay may be used effectively for high-risk, large complex defects. Early outcomes with this technique are promising. The authors believe this combination highlights benefits from both materials because the ADM facilitates tissue ingrowth and revascularization, whereas the synthetic component provides structural durability. Additional studies with larger sample sizes are necessary to further explore the benefits of the combination technique to determine if outcomes are better than either material alone when used to reconstruct high-risk wounds after larger resections.
authors.affiliation: From the *Department of Surgery, †Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD; ‡Division of Pediatric Surgery, Department of Surgery, Beaumont Health System, Royal Oak, MI; §Division of Thoracic Surgery, Department of Surgery, and ∥Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Saïd C
authors.initials: SC
authors.lastname: Azoury
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.forename: Sami H
authors.initials: SH
authors.lastname: Tuffaha
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.forename: Anne C
authors.initials: AC
authors.lastname: Fischer
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Tufaro
mesh_terms: D001672:Biocompatible Materials; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology* / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000517:prevention & control; D035441:Thoracic Wall / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials