Holton Luther H, Chung Thomas, Silverman Ronald P, Haerian Hafez, Goldberg Nelson H, Burrows Whitney M, Gobin Andrea, Butler Charles E
Baltimore, Md.; and Houston, Texas From the Divisions of Plastic and Reconstructive Surgery and Cardiothoracic Surgery, University of Maryland Medical Center, and Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2007 Apr 1;119(4):1238-1246. doi: 10.1097/01.prs.0000254347.36092.9c.
Synthetic mesh is used for chest wall reconstruction, but infection or exposure can occur and necessitate removal. Human acellular dermal matrix (AlloDerm) has been used to reconstruct musculofascial defects in the trunk with low infection and herniation rates. AlloDerm may have advantages over synthetic mesh for chest wall reconstruction. This study compared outcomes and repair strengths of AlloDerm to expanded polytetrafluoroethylene mesh used for repair of rib cage defects.
A 3 x 3-cm, full-thickness, lateral rib cage defect was created in each rabbit and repaired with expanded polytetrafluoroethylene (n = 8) or acellular dermal matrix (n = 9). At 4 weeks, the animals were euthanized and evaluated for lung herniation/dehiscence, strength of adhesions between the implant and intrapleural structures, and breaking strength of the implant materials and the implant-fascia interface. Tissue sections were analyzed with histologic and immunohistochemical staining to evaluate cellular infiltration and vascularization.
No herniation or dehiscence occurred with either material. The incidence and strength of adhesions was similar between materials. The mean breaking strength of the AlloDerm-fascia interface (14.5 +/- 8.9 N) was greater than the expanded polytetrafluoroethylene-fascia interface (8.7 +/- 4.4 N; p = 0.027) and similar to the rib-intercostal-rib interface of the contralateral native chest wall (14.0 +/- 5.6 N). The AlloDerm grafts became infiltrated with cells and vascularized after implantation.
AlloDerm used for chest wall reconstruction results in greater implant-defect interface strength than expanded polytetrafluoroethylene. The ability of AlloDerm to become vascularized and remodeled by autologous cells and to resist infection may be advantageous for chest wall reconstruction.
合成网片用于胸壁重建，但可能发生感染或外露，需要移除。人脱细胞真皮基质（AlloDerm）已用于重建躯干的肌筋膜缺损，感染和疝形成率较低。在胸壁重建中，AlloDerm可能比合成网片具有优势。本研究比较了AlloDerm与用于修复胸廓缺损的膨体聚四氟乙烯网片的治疗效果和修复强度。
在每只兔子身上制造一个3×3厘米的全层外侧胸廓缺损，并用膨体聚四氟乙烯（n = 8）或脱细胞真皮基质（n = 9）进行修复。4周时，对动物实施安乐死，并评估肺疝形成/裂开情况、植入物与胸膜内结构之间粘连的强度以及植入材料和植入物-筋膜界面的断裂强度。用组织学和免疫组织化学染色分析组织切片，以评估细胞浸润和血管形成情况。
两种材料均未发生疝形成或裂开。材料之间粘连的发生率和强度相似。AlloDerm-筋膜界面的平均断裂强度（14.5±8.9牛）大于膨体聚四氟乙烯-筋膜界面（8.7±4.4牛；p = 0.027），且与对侧正常胸壁的肋骨-肋间-肋骨界面（14.0±5.6牛）相似。植入后，AlloDerm移植物被细胞浸润并形成血管。
用于胸壁重建的AlloDerm比膨体聚四氟乙烯具有更高的植入物-缺损界面强度。AlloDerm能够被自体细胞血管化和重塑并抵抗感染，这对于胸壁重建可能是有利的。
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