Chest Wall Reconstruction Using Biologic Mesh to Cover Soft Tissue Defects: A Narrative Review.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.