Biological materials in chest wall reconstruction: initial experience with the Peri-Guard Repair Patch

Abstract

Objective: This study analyses the efficacy of the bovine Peri-Guard Repair Patch for chest wall reconstruction.

Methods: 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.

Results: 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.

Conclusions: 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.