Biologic Versus Synthetic Mesh For Chest Wall Reconstruction: A Systematic Literature Review
Peyton Terry, MD, Chris A. Campbell, MD.
University of Virginia, Charlottesville, VA, USA.
PURPOSE: There is no consensus on mesh selection for chest wall reconstruction between rigid synthetic materials designed to maintain pulmonary function versus elastic biologic meshes with a favorable surgical healing profile. Few adequately-powered studies have directly compared the these materials in chest wall reconstruction prompting a systematic comparison of pulmonary and surgical site healing outcomes between the two groups.
METHODS: A systematic review protocol submitted to Prospero investigating chest wall reconstruction articles using either synthetic or biologic mesh for the reconstruction of chest wall defects was performed and patients with both surgical wound healing and pulmonary outcomes data were analyzed for the coverage period 1995-2020. Patient demographics, surgical descriptive information, and post-operative outcomes were analyzed.
RESULTS: Thirty-seven studies were included, with 287 patients with biologic mesh placement and 551 patients with synthetic mesh. The biologic group exhibited lower rates of surgical site seroma (2.4% vs. 5.0%; p=0.041), reoperation (3.1% vs. 7.8%; p=0.011) explantation (0.7% vs. 5.4%; p=0.001) and overall surgical site complications (13.6% vs. 20.3%; p=0.031). Of the pulmonary outcomes evaluated, the biologic mesh group had less paradoxical chest wall movement (0% vs. 2.4%; p=0.009), and atelectasis (0% vs. 2.2%; p=0.013) with no difference in overall respiratory complication rate. Total respiratory and surgical complication rate (18.9% vs. 28.4%; p=0.009) was significantly lower for the biologic group.
CONCLUSION: A review of published clinical chest wall reconstruction outcomes shows lower overall surgical site complication rate, re-operation and mesh explantation with biologic mesh compared to synthetic mesh usage without compromising pulmonary outcomes.
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