# A new option of reconstruction after extensive chest wall resection

## TL;DR

This paper introduces Vitagraft®, a new synthetic and absorbable material for chest wall reconstruction, and reports on its initial use and biocompatibility in patients.

## Contribution

The first clinical assessment of Vitagraft® in chest wall reconstruction, a novel synthetic, biocompatible, and absorbable material.

## Key findings

- Vitagraft® showed good biocompatibility in chest wall reconstruction cases.
- Reoperation was needed in 28% of cases, with 14% requiring prosthesis removal.
- Postoperative imaging indicated favorable integration of the material.

## Abstract

•Chest wall reconstruction plays an important role in the outcomes of chest wall surgery. The ideal prosthesis characteristics are already established, even though, the best choice is not well decided.•The authors propose a new prosthesis for chest wall reconstruction.•This study is the first to assess patients with chest wall disease reconstructed with Vitagraft®. It is a synthetic, biocompatible, and absorbable material, which has never been found in thoracic surgery before.•Finally, the use of Vitagraft® has been shown to have good prosthesis biocompatibility.

Chest wall reconstruction plays an important role in the outcomes of chest wall surgery. The ideal prosthesis characteristics are already established, even though, the best choice is not well decided.

The authors propose a new prosthesis for chest wall reconstruction.

This study is the first to assess patients with chest wall disease reconstructed with Vitagraft®. It is a synthetic, biocompatible, and absorbable material, which has never been found in thoracic surgery before.

Finally, the use of Vitagraft® has been shown to have good prosthesis biocompatibility.

Chest wall reconstruction plays an important role in the outcomes of chest wall resection. However, there being a huge variety of materials at disposable, the best option has not yet been well defined. The Vitagraft® is a synthetic and absorbable material, that works as an osteoinduction and osteoconduction for bone regeneration. It consists of a β-phase Tricalcium Phosphate Ceramic (β-TCP) and the Polylactic Glycolic Acid Polymer (PLGA). Therefore, this study intends to assess the safety of Vitagraft® use in the chest wall.

A prospective study, in which the patient’s chest was reconstructed with Vitagraft®. Each patient was followed after the procedure for at least three months. The following variables were considered: KPS, ECOG, preoperative treatment, defect size, myocutaneous flap, the time between surgeries, complications, and mortality.

Eight resections were performed due to tumor findings. One reconstruction was a treatment for sternal cleft, another for Poland’s syndrome, and finally as a consequence of late sternal dehiscence. Primary closure was performed in 63.6 % of the patients. Vitagraft® was used in association with mesh in eight cases. Reoperation was required in two cases, and prosthesis removal for one of them. Respiratory failure and major systemic complications were not evidenced.

In the present study, the first to assess Vitagraft® in chest wall reconstruction, the second operation was necessary for 28 %, and removal was mandatory for 14 %. Until now, chest postoperative tomography has been showing good prosthesis biocompatibility. The authors need further details about the ossification time especially relating to the size of the resection.