Download PDF
CC BY 4.0 · Surg J (N Y) 2022; 08(03): e187-e191
DOI: 10.1055/s-0042-1755622
Case Report

The Use of Acellular Dermal Matrix (Integra Single Layer) for the Correction of Malformative Chest Wall Deformities: First Case Series Reported

Carlos Delgado-Miguel 
1   Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
2   Department of Pediatric Plastic Surgery, La Paz Children's Hospital, Madrid, Spain
,
Miriam Miguel-Ferrero
2   Department of Pediatric Plastic Surgery, La Paz Children's Hospital, Madrid, Spain
,
Antonio Muñoz-Serrano 
1   Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
2   Department of Pediatric Plastic Surgery, La Paz Children's Hospital, Madrid, Spain
,
Mercedes Díaz
2   Department of Pediatric Plastic Surgery, La Paz Children's Hospital, Madrid, Spain
,
Juan Carlos López-Gutiérrez
2   Department of Pediatric Plastic Surgery, La Paz Children's Hospital, Madrid, Spain
,
Carlos De la Torre
1   Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Introduction Autologous tissue transfers have been used in chest wall reconstruction for decades, with high morbidity. Recently, acellular dermal matrices (ADMs) have emerged as an alternative. The aim of this article is to report our initial experience in the reconstruction of malformative chest wall deformities with ADM.

Methods A prospective observational study was performed in patients with malformative chest wall deformities, who were reconstructed with ADM at our institution between 2018 and 2020. We analyzed demographic variables, surgical features, postoperative complications, and cosmetic results at 12 months' follow- up.

Results Four male patients were included (median age: 16 years). Two patients had bilateral costal anomalies, one patient had a unilateral chest deformity, and one patient had Poland syndrome. In all patients, blunt dissection of the subcutaneous cellular tissue overlying the defect was performed through 2.5 to 3 cm skin incisions, creating a pouch. Afterwards, several sheets of Integra Single Layer were placed in the pouch, to replace the volume defect. All patients were discharged same-day. No postoperative infections, hematomas, or seromas were observed. Only one patient presented with a partial surgical wound dehiscence. Revisions were performed at 1, 3, 6, and 12 months. All 4 patients were satisfied with the cosmetic outcome (Nuss Questionnaire: median score: 16 points; Q1–Q3: 22–26).

Conclusion The use of ADM in malformative chest wall deformities reconstruction has not been previously described in children. This study demonstrates that the use of ADM is a safe and reliable technique. However, more studies with long-term follow-up are warranted.

Keywords

minimally invasive surgery - chest wall deformities - children - Poland syndrome


Publication History

Received: 08 December 2021

Accepted: 20 May 2022

Article published online:
16 August 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Mansour KA, Thourani VH, Losken A. et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73 (06) 1720-1725 , discussion 1725–1726
    CrossrefPubMedGoogle Scholar
  • 2 Seder CW, Allen MS, Nichols FC. et al. Primary and prosthetic repair of acquired chest wall hernias: a 20-year experience. Ann Thorac Surg 2014; 98 (02) 484-489
    CrossrefPubMedGoogle Scholar
  • 3 Wiegmann B, Korossis S, Burgwitz K. et al. In vitro comparison of biological and synthetic materials for skeletal chest wall reconstruction. Ann Thorac Surg 2015; 99 (03) 991-998
    CrossrefPubMedGoogle Scholar
  • 4 Miller DL, Force SD, Pickens A, Fernandez FG, Luu T, Mansour KA. Chest wall reconstruction using biomaterials. Ann Thorac Surg 2013; 95 (03) 1050-1056
    CrossrefPubMedGoogle Scholar
  • 5 Hsu PW, Salgado CJ, Kent K. et al. Evaluation of porcine dermal collagen (Permacol) used in abdominal wall reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (11) 1484-1489
    CrossrefPubMedGoogle Scholar
  • 6 Rocco G, Mori S, Fazioli F, La Rocca A, Martucci N, Setola S. The use of biomaterials for chest wall reconstruction 30 years after radical surgery and radiation. Ann Thorac Surg 2012; 94 (04) e109-e110
    CrossrefPubMedGoogle Scholar
  • 7 Beres A, Christison-Lagay ER, Romao RL, Langer JC. Evaluation of Surgisis for patch repair of abdominal wall defects in children. J Pediatr Surg 2012; 47 (05) 917-919
    CrossrefPubMedGoogle Scholar
  • 8 Begum T, Farrelly PJ, Craigie RJ. Non-cross-linked porcine acellular dermal matrix (Strattice Tissue Matrix) in pediatric reconstructive surgery. J Pediatr Surg 2016; 51 (03) 461-464
    CrossrefPubMedGoogle Scholar
  • 9 Lin SR, Kastenberg ZJ, Bruzoni M, Albanese CT, Dutta S. Chest wall reconstruction using implantable cross-linked porcine dermal collagen matrix (Permacol). J Pediatr Surg 2012; 47 (07) 1472-1475
    CrossrefPubMedGoogle Scholar
  • 10 Lawson ML, Cash TF, Akers R. et al. A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg 2003; 38 (06) 916-918
    CrossrefPubMedGoogle Scholar
  • 11 Später T, Frueh FS, Metzger W, Menger MD, Laschke MW. In vivo biocompatibility, vascularization, and incorporation of Integra® dermal regenerative template and flowable wound matrix. J Biomed Mater Res B Appl Biomater 2018; 106 (01) 52-60
    CrossrefPubMedGoogle Scholar
  • 12 Cothren CC, Gallego K, Anderson ED, Schmidt D. Chest wall reconstruction with acellular dermal matrix (AlloDerm) and a latissimus muscle flap. Plast Reconstr Surg 2004; 114 (04) 1015-1017
    CrossrefPubMedGoogle Scholar
  • 13 Ge PS, Imai TA, Aboulian A, Van Natta TL. The use of human acellular dermal matrix for chest wall reconstruction. Ann Thorac Surg 2010; 90 (06) 1799-1804
    CrossrefPubMedGoogle Scholar
  • 14 Ortiz JA. Poland's breast reconstruction with decellularized human dermal allograft. Mil Med 2014; 179 (02) e249-e252
    CrossrefPubMedGoogle Scholar
  • 15 Nagayasu T, Yamasaki N, Tagawa T. et al. Long-term results of chest wall reconstruction with DualMesh. Interact Cardiovasc Thorac Surg 2010; 11 (05) 581-584
    CrossrefPubMedGoogle Scholar
  • 16 Menon NG, Rodriguez ED, Byrnes CK, Girotto JA, Goldberg NH, Silverman RP. Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg 2003; 50 (05) 523-527
    CrossrefPubMedGoogle Scholar
  • 17 Freedman BE. Full incorporation of Strattice™ Reconstructive Tissue Matrix in a reinforced hiatal hernia repair: a case report. J Med Case Reports 2012; 6: 234
    CrossrefPubMedGoogle Scholar