Experience with Porcine Acellular Dermal Collagen Mesh (Permacol™ Surgical Implant) in Chest Wall Reconstruction after Resection for Rib Osteomyelitis

Abstract

Chest wall reconstruction after rib resection is essential to ensuring chest wall stability, avoiding flail chest and pulmonary hernia, and improving pulmonary function. Traditionally, a synthetic mesh and a musculocutaneous flap have been used to bridge the chest wall defect. However, a risk of secondary prosthesis infection exists. Acellular dermal collagen mesh implants (Permacol™) are indicated for the reconstruction and reformation of human soft connective tissue. A case of a complex chest wall reconstruction after rib resection for osteomyelitis due to staphylococcus aureus infection in a malnourished, immunosuppressed, and methadone-addicted patient is presented. The patient underwent a left posterolateral thoracotomy and chest wall resection, involving three ribs and the soft tissues overlying an infected cutaneous fistula. The chest wall was reconstructed using a 28 × 18 cm piece of porcine sterile acellular dermal collagen mesh. A successful chest wall repair was achieved with no incisional herniation and with complete mesh incorporation, allowing physiologic respiratory movements. A typical wound seroma developed and resorbed over the following months. There was no infection. In conclusion, this case report suggests that Permacol™ surgical implant can be used successfully as an alternative to synthetic mesh in reconstruction of an infected chest wall.