Chest Wall Reconstruction EvolutionOveraDecade andExperience With aNovel Techniquefor Complex Defects

Background: Chest wall reconstruction (CWR) with biologic matrices hasgained 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 forCWR while reviewing and highlighting a novel approach using a biologic inlayand synthetic onlay technique for larger, complex high-risk defects.Methods: A retrospective review was performed of all patients who underwentfullthicknesschestwallresectionandreconstructionduringa10-year period.Patient characteristics, comorbidities, operative data, as well as postoperativewound complications and outcomes were reviewed. Different reconstructivemethods and materials were reviewed and compared.Results: FromDecember2003 toJanuary2014,atotalof81patients underwentCWR. The indications for resection/reconstruction included oncologic in 49 patients(60.5%), desmoids tumorsin 10 (12.3%), bronchopleural fistula in3 (3.7%), in-fection in 7 (8.6%), and anatomic deformity in 7 (8.6%) patients. Synthetic and/oracellulardermalmatrices(ADM)reconstructionwasusedin59patients(10biologic,22synthetic,and27biologicADMinlay/syntheticonlaycombination).Onaver-age, 2.5, 3.5,and 3.6 ribswere resectedinthe biologic, synthetic,andcombinationgroup, respectively (P = 0.1). A greater number of patients in the combinationgroup had a history of chemotherapy and/or radiation therapy ( P =0.03)thanthesyntheticorbiologicalonegroups. Riskanalysisdemonstratedanassociationbetween the numberofribs resected and postoperative chest wallcomplications.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:Inthelargestsingleinstitutionstudycomparingtheuseofdifferentreconstructivematerials,includingADMinCWR,theauthorsdemonstratethatabiologic inlay/synthetic onlay may be used effectively for high-risk, large com-plex defects. Early outcomes with this technique are promising. The authorsbelieve this combination highlights benefits from both materials because theADM facilitates tissue ingrowth and revascularization, whereas the syntheticcomponent provides structural durability. Additional studies with larger samplesizes are necessary to further explore the benefits of the combination techniquetodetermineifoutcomesarebetterthaneithermaterialalonewhenusedtorecon-struct high-risk wounds after larger resections.Key Words: chest wall resection, reconstruction, acellular dermal matrix,synthetic, combination(Ann Plast Surg 2015;00: 00–00)