Velotta Jeffrey B, Hammer Jason, Mukhatyar Vivek
Department of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California; Department of Clinical Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
Medical Affairs, Allergan Aesthetics, an AbbVie Company, Branchburg, New Jersey.
J Surg Res. 2025 Jul;311:98-105. doi: 10.1016/j.jss.2025.04.023. Epub 2025 May 23.
Chest wall reconstruction (CWR) is used in functional and/or aesthetic impairments of the thoracic wall following resection. This review summarizes literature for soft tissue coverage with biologic mesh in CWR and reports use of a porcine-derived acellular dermal matrix in CWR.
A literature search identified studies that use biologic mesh in CWR, and expert opinion for the use of a porcine acellular dermal matrix and muscle flap reconstruction to repair large chest wall defects is provided.
CWR with biologic mesh is used to provide soft tissue coverage for various medical conditions, including oncologic tumor resections, trauma, congenital malformations, and in complex procedures, such as large thoracic defects, presence of infection, and prior radiation of the chest wall. Compared with synthetic mesh, fewer overall complications, infections, and mesh explantations have been reported with biologic mesh in retrospective studies of patients who underwent CWR with surgical mesh. However, there are limited published data on the use of biologic mesh for CWR, and there are no published randomized controlled trials comparing synthetic versus biologic mesh in CWR. A case study for the use of a porcine acellular dermal matrix and muscle flap reconstruction to repair large chest wall defects demonstrates a successful outcome with more than 6 y of follow-up.
Use of biological mesh in CWR is supported by literature and expert opinion. However, more robust clinical data on risks and benefits of types of mesh are needed to aid surgeons in selecting mesh.
胸壁重建（CWR）用于切除术后胸壁的功能和/或美观受损情况。本综述总结了CWR中使用生物补片进行软组织覆盖的文献，并报告了猪源脱细胞真皮基质在CWR中的应用。
通过文献检索确定在CWR中使用生物补片的研究，并提供关于使用猪脱细胞真皮基质和肌皮瓣重建修复大面积胸壁缺损的专家意见。
使用生物补片的CWR用于为各种医疗状况提供软组织覆盖，包括肿瘤切除、创伤、先天性畸形，以及在复杂手术中，如大面积胸壁缺损、存在感染和胸壁既往接受过放疗的情况。在接受手术补片的CWR患者的回顾性研究中，与合成补片相比，生物补片报告的总体并发症、感染和补片取出情况较少。然而，关于生物补片用于CWR的已发表数据有限，且尚无比较合成补片与生物补片在CWR中应用的随机对照试验发表。一项使用猪脱细胞真皮基质和肌皮瓣重建修复大面积胸壁缺损的病例研究显示，随访超过6年结果成功。
文献和专家意见支持在CWR中使用生物补片。然而，需要更有力的关于补片类型风险和益处的临床数据，以帮助外科医生选择补片。
