Landon A. Hackley

Background: Chest wall reconstruction plays a crucial role in restoring the integrity compromised by trauma and cancer, especially lung and breast cancers, often requiring surgical intervention due to tumor invasion. The intricate anatomy of the human torso is vital for organ protection, respiration, and postural support. Despite its significance, there is a paucity of literature that makes comparisons between acellular dermal matrices (ADMs) and synthetic meshes (SMs) in chest wall reconstruction. ADMs offer advantages in tissue integration, while SMs provide mechanical support with varying tissue responses. Conflicting evidence on complication rates and cost-effectiveness highlights the need for comprehensive evaluation. This study systematically analyzes patient outcomes following ADM and SM utilization in chest wall reconstruction procedures, aiming to improve patient safety and outcomes via retrospective literature review.

Methods: Data for this comparative analysis were sourced from PubMed with keyword searches including: “acellular dermal matrices chest wall reconstruction”, “synthetic mesh chest wall reconstruction”, “acellular dermal matrices vs synthetic mesh”, and “acellular dermal matrices vs synthetic mesh chest wall reconstruction.” The search was conducted to encompass relevant studies, reviews, and meta-analyses with exclusion criteria of studies published more than five years prior to this review.

Results: Complications associated with acellular dermal matrices (ADMs) include surgical site infections, necrosis, and hematoma, often requiring revision procedures. Synthetic meshes exhibit lower complication rates on average, with notable complications being seromas and surgical site infections.^1,2,3,11 ADMs decrease fibrotic reactions but may lack sufficient rigidity for chest wall protection.^3,4 Synthetic meshes offer excellent support, particularly for reinforcing chest structures.^5,6 ADM-assisted reconstructions have higher rates of surgical site infections and reoperation compared to non-ADM cases. Synthetic meshes show lower infection and seroma rates in breast reconstruction^7,8 and are more cost-effective, averaging $15,776 compared to ADMs at $23,844.⁹ While synthetic meshes dominate in the operating room, the choice between ADMs and synthetic meshes depends on case-specific factors like infection risk and tissue response, highlighting the importance of tailored treatment decisions.^4,7,10

Conclusion: Through a retrospective analysis of over 10 reviews, clinical studies, and abstracts, it appears that synthetic mesh materials are less susceptible to complications and more cost-effective than ADMs for chest wall reconstruction procedures. However, this study highlights the need for a prospective clinical study that directly compares ADMs to SMs in chest wall reconstruction to further elucidate risks and benefits of each modality to minimize complications and maximize patient outcomes.

Works Cited

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