Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery

Our plain-English summary of Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery, by A. Barua, J.A. Catton, L. Socci, et al (The Annals of Thoracic Surgery, 2012).

The study

• Authors: A. Barua, J.A. Catton, L. Socci, A. Raurell, M. Malik, E. Internullo, A.E. Martin-Ucar
• Journal: The Annals of Thoracic Surgery
• Published: 2012;94(5):1701-5
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Synthetic materials have traditionally been used for tissue reconstruction in thoracic surgery. New biomaterials have been tested in other areas of surgery with good results. The aim of our study is to evaluate our initial experience using prostheses in extended thoracic surgery.

Methods: A review was performed of all patients who underwent extended surgical procedures requiring soft tissue reconstruction with bioprosthetic materials after thoracic surgery from August 2009 to August 2011. A total of 44 consecutive patients were included. Operations involved radical pleurectomy and decortication for mesothelioma (n = 29), extended operations for thoracic malignancies (n = 8), surgery for trauma or perforated organs or complications (n = 6), and for benign infectious causes (n = 1).

Results: A total of 76 patches were used in 44 patients (median of 2; range 1 to 3 per patient). Median hospital stay was 13 (range 5 to 149) days. Three patients died during the postoperative period (6.8%); pulmonary embolism 5 days after intrapericardial pneumonectomy with chest wall reconstruction, fatal pneumonia 26 days after radical pleurectomy and decortication for mesothelioma, and bronchopleural fistula 11 days after pneumonectomy with diaphragm and atrium excision for lung cancer after initial chemoradiotherapy. No other surgical exploration or removal of patches has been required for infection.

Conclusions: Our initial experience of using bioprosthetic patches for soft tissue reconstruction in thoracic surgery has proven satisfactory with overall acceptable results. The infection rates are low even when a proportion of procedures were performed under contaminated environments. Biologic prosthesis should be part of the surgical options to reconstruct soft tissues in thoracic surgery.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This article reviewed the authors' own patients at a regional thoracic surgery unit in Nottingham, United Kingdom, who had soft tissue or chest wall reconstruction with biological patches between August 2009 and August 2011. It included 44 consecutive patients (37 male, 7 female, median age 66). Twenty-nine had pleurectomy and decortication surgery for malignant pleural mesothelioma. The others had surgery for other chest cancers, trauma, perforations, complications or infection. The patches were porcine (pig) dermal collagen (Permacol, 38 patients) or bovine (cow) pericardium (Veritas, 6 patients). In total, 76 patches were used, mainly to replace the diaphragm and pericardium. Three patients died after surgery (6.8%), one of them from pneumonia 26 days after mesothelioma surgery. One mesothelioma patient developed an empyema (an infected collection in the chest) that needed another operation. Four others were readmitted for antibiotics because empyema was suspected, and none needed surgery or patch removal. Over a median follow-up of 11 months, the authors saw no patch-related complications or infections after the early postoperative period. The study had no comparison group. The authors concluded the patches can be used successfully. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review (case series) of consecutive patients from a single surgical team, with no control group
• Who was studied: 44 consecutive patients (37 male, 7 female, median age 66, range 55 to 89) treated at Nottingham University Hospitals NHS Trust, UK, between August 2009 and August 2011. Indications were malignant pleural mesothelioma (29), extended operations for thoracic malignancies (8), trauma, perforated organs or complications (6), and benign infection (1).
• Exposure: Not asbestos. The intervention studied was biological patches: Permacol (porcine dermal collagen matrix) in 38 patients and Veritas (non cross-linked bovine pericardium) in 6 patients.
• Main results:
  • 76 patches were used in the 44 patients (median 2, range 1 to 3 per patient), mainly to replace the diaphragm and pericardium
  • Median hospital stay for all 44 patients was 13 days (range 5 to 149)
  • Three of the 44 patients died during the postoperative period (6.8%). One died of pulmonary embolism after pneumonectomy with chest wall reconstruction. One died of pneumonia 26 days after radical pleurectomy and decortication for mesothelioma. One died after a bronchopleural fistula following pneumonectomy for lung cancer.
  • One patient developed an empyema after mesothelioma surgery that required reexploration and long-term drainage
  • Four patients were readmitted after mesothelioma surgery for intravenous antibiotics because empyema was suspected
  • None of these four patients required drainage, surgery, or removal of the prosthesis
  • The 9 patients who had nonelective (urgent or emergency) surgery were all discharged and did not have postoperative empyemas or surgical complications
  • With a median follow-up of 11 months (range 1 to 24), the authors saw no patch-related complications or infections after the initial postoperative period
• The authors' conclusion: The authors concluded that bioprostheses can be used successfully to reconstruct tissues in the chest wall and chest cavity. They considered them a safe and useful alternative to conventional synthetic materials and autologous flaps, especially in extended thoracic surgery and contaminated environments.
• Limitations the authors state:
  • Review of a single surgical team with no control group
  • Modest sample size for some procedures and a relatively short follow-up period
  • The patient population was very heterogeneous in surgical indications and patch locations

Topics

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Mesothelioma, Pneumonectomy, Diaphragm, Lung Cancer.

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• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report — C. Qin, Q. Xia, et al. (2023)
• Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch® — P. Zardo, R. Zhang, et al. (2011)
• Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma — F. Chen, A. Yoshizawa, et al. (2011)

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