Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Eur J Cardiothorac Surg. 2010 Mar;37(3):602-5. doi: 10.1016/j.ejcts.2009.07.012. Epub 2009 Sep 3.
This study analyses the efficacy of the bovine Peri-Guard Repair Patch for chest wall reconstruction.
Nine consecutive patients (seven males, median age: 61 years) underwent chest wall repair due to either secondary incisional herniation development after lung transplantation (LTX, n=3 patients) or malignant disease with chest wall infiltration. In all cases, repair was performed with a Peri-Guard Repair Patch (Synovis, St. Paul, MN, USA). At follow-up (4+/-2 months), quality of life, signs of re-herniation and incorporation of mesh (radiograph, blood samples and ultrasound) were assessed.
In all patients, a successful chest wall repair could be achieved and no signs of re-herniation were found. Oncologic patients with a diagnosis of desmoid tumour, primary histiocytosis of ribs, sarcoma or lung cancers were accessed through posterolateral thoracotomy and received a resection of two to four ribs. Post-LTX repair was performed by anterior mini-thoracotomy without rib resection. At follow-up, 80% of the patients presented with totally regained quality of life, with no signs of local infection, altered white blood cell (WBC) counts or elevated C-reactive protein (CRP) levels. On chest X-ray, only one patient showed areas of patch calcification, while all others were unremarkable. Chest ultrasound imaging confirmed the absence of adhesions, haematoma or seroma. In all cases, normal expansion and respiratory movement of the underlying lung were observed.
To achieve satisfactory results after chest wall reconstruction, a material with high-tensile strength, preferably soft structure, availability, ease of use and high biocompatibility is required. Especially in immunosuppressed patients, the biological Peri-Guard Repair Patch might be superior to the use of an artificial material.
本研究分析了牛 Peri-Guard 修复补丁在胸壁重建中的疗效。
9 例连续患者（7 例男性，中位年龄：61 岁）因肺移植（LTX）后继发性切口疝发展（3 例患者）或胸壁浸润性恶性疾病而行胸壁修复。所有病例均采用 Peri-Guard 修复补丁（Synovis，明尼苏达州圣保罗，美国）进行修复。在随访时（4+/-2 个月），评估了生活质量、重新出现疝和网片融合的迹象（影像学、血液样本和超声）。
所有患者均成功完成胸壁修复，未发现再次出现疝的迹象。诊断为硬纤维瘤、肋骨原发性组织细胞增生症、肉瘤或肺癌的肿瘤患者通过后外侧开胸术接受 2 至 4 根肋骨切除，LTX 修复采用前侧小开胸术不切除肋骨。随访时，80%的患者生活质量完全恢复，无局部感染、白细胞计数改变或 C 反应蛋白（CRP）水平升高的迹象。胸部 X 线检查仅 1 例患者显示补丁钙化区，其余均未见异常。胸部超声成像证实无粘连、血肿或血清肿。在所有情况下，均观察到下方肺的正常扩张和呼吸运动。
为了在胸壁重建后获得满意的效果，需要一种具有高强度、优选柔软结构、可用性、易用性和高生物相容性的材料。特别是在免疫抑制患者中，生物 Peri-Guard 修复补丁可能优于使用人工材料。
