Experience of biological implants in thoracic surgery for soft tissue and chest wall reconstruction in clean and contaminated environments.

BACKGROUND: Biological mesh has become an integral tool in surgery for reconstructive procedures. Acellular dermal matrices derived from porcine or bovine collagen scaffolds provide a durable implant material for use in reconstruction of the chest wall, and soft tissues including the pericardium and diaphragm. We aimed to present our experience of biological meshes used for thoracic reconstructive procedures for a wide range of clinical indications by a single surgeon, comparing the effect of contaminated and clean surgical environments and implant materials. METHODS: We retrospectively reviewed all patients who had undergone thoracic surgery reconstructive procedures under a single surgical team with biological mesh material over a 16-year period from March 2009 to April 2025. Data included indication for surgery, operative procedure, surgical site, biological implant material (cross-linked or non-cross-linked), postoperative infection, in-hospital mortality and reoperation rate. We directly compared the results between patients undergoing the procedure in infected/contaminated versus clean cases. RESULTS: In total 152 consecutive procedures were performed utilising 212 patches. Median age was 65 years (range, 24-84 years) and majority treated were males 104/152 (68%). Indications for surgery included total pleurectomy for mesothelioma (38%), resection of extended thoracic malignancy (33%), surgery for trauma or related complications (19%), and benign conditions including adult congenital abnormalities (10%). Cross-linked biological mesh had a significantly reduced surgical site infection rate compared to non-cross-linked biological mesh (n=6; 7% vs. n=16; 23%, P=0.008). This remained significant following adjustment for key clinical confounding factors [adjusted odds ratio (OR) 0.289, 95% confidence interval (CI): 0.105-0.793, P=0.02]. Direct comparison of contaminated environments versus clean showed surgical site infections postoperatively were not significantly different (24% vs. 12% P=0.09). No biological patch necessitated explantation due to infection. In-hospital mortality and reoperation rates remained low at 4% and 9% respectively. CONCLUSIONS: Our study evaluates and supports the continued use of biological patches for thoracic reconstruction of soft tissues and chest wall. Biological patches have a role in a diverse range of surgical indications including extended resection of malignancy and traumatic injuries and can be feasibly used in high risk contaminated surgical fields.