title: Polytetrafluoroethylene or Acellular Dermal Matrix for Diaphragmatic Reconstruction?
abstract: BACKGROUND
  We aimed to evaluate the impact of collagen matrix in the reconstruction of the diaphragm.
  
  
  METHODS
  We queried the electronic medical record for patients who had resection of the diaphragm and simultaneous pulmonary resection between 1999 and 2016. All reconstructions were performed with either polytetrafluoroethylene or acellular dermal matrix. We evaluated the rate of empyema and herniation in each group.
  
  
  RESULTS
  A total of 208 patients met inclusion criteria. Polytetrafluoroethylene was used in 168 cases (80.8%) and dermal matrix in 40 cases (19.2%). Dermal matrix was used in 8 extrapleural pneumonectomies (5.4%), in 26 pleurectomy decortications (55.3%), and in 6 other types of resections (40%). Follow-ups were for a median of 15.0 months in the polytetrafluoroethylene group and 11.6 months in the dermal matrix group. Patients in the dermal matrix group had a chest tube for a median of 2.5 days longer than patients with polytetrafluoroethylene (p = 0.006). Empyema occurred in 11 polytetrafluoroethylene reconstructions (6.5%) and 3 dermal matrix reconstructions (7.5%) (p = 0.735). Seven patients (63.6%) with polytetrafluoroethylene infection required removal of the graft, whereas none in the dermal matrix group needed removal (p = 0.351). There were nine herniations in the polytetrafluoroethylene group and four in the dermal matrix group (p = 0.281), all were acute and due to anchorage failure.
  
  
  CONCLUSIONS
  Although infection rates were similar between polytetrafluoroethylene and acellular dermal matrix, re-operation for removal was not necessary in the latter. The use of a thick acellular dermal matrix may be a reasonable option when diaphragmatic reconstruction is potentially associated with a higher risk of infection.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Juri K
authors.initials: JK
authors.lastname: Bassuner
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Mara B
authors.initials: MB
authors.lastname: Antonoff
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.affiliation: Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Boris
authors.initials: B
authors.lastname: Sepesi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas. Electronic address: rjmehran@mdanderson.org.
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000601:surgery; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000601:surgery; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D013902:Radiography, Thoracic; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D011138:Polytetrafluoroethylene