A paradigm shift for diaphragmatic and chest wall reconstruction using a bovine acellular dermal matrix: an analysis versus synthetic meshes

Objectives Recently, biologic meshes have gained increasing popularity in soft tissue reconstruction. The aim of this study was to investigate the use of a bovine acellular dermal matrix (SurgiMend, Integra LifeSciences, Princeton, NJ, USA) in diaphragmatic and chest wall reconstruction by comparing it with synthetic meshes. Methods Consecutive patients who underwent diaphragmatic and/or chest wall reconstruction at a single center from 2016 to 2021 were retrospectively reviewed. Outcome measures included surgical site complications, readmission, and reoperation. Results Sixty-six patients underwent diaphragmatic and/or chest wall reconstruction for a malignant (74.2%) or benign (25.8%) disease. SurgiMend was used in 26 (39.4%) patients and a synthetic mesh in 40 (60.6%) patients. There were no significant differences in baseline characteristics between the groups. Surgical site complications included prolonged air leak (12.1%), pleural effusion (9.1%), pneumothorax (3%), empyema (1.5%), and wound infection (1.5%). The patients in the synthetic mesh group developed a significantly higher rate of surgical site complications compared to those in the SurgiMend group (37.5% vs. 11.5%; p = 0.025). Similarly, the readmission rate was significantly higher in the synthetic mesh group (17.5% vs. 0%; p = 0.037), with causes including pleural effusion (n = 3), pneumothorax (n = 2), empyema (n = 1), and pneumonia (n = 1). Among the study cohort, only 1 patient with a synthetic mesh underwent reoperation (p > 0.99). Conclusions The use of surgiMend in diaphragmatic and chest wall reconstruction is associated with fewer surgical site complications and readmissions compared to synthetic meshes.