Use of porcine acellular dermal matrix to repair lung Hernia after minithoracotomy: A case report with 6-Year follow-up

Abstract

Lung hernia following minimally invasive cardiac surgery is rare with few reported cases in the literature. Surgical repair is debated, and several methods have been described including a variety of synthetic and biological materials. We report a case of a 36-year-old woman who developed lung hernia and a strong retraction of the pectoralis major muscle after minithoracotomy that was performed for mitral valve surgery. The herniated lung was reduced and the chest wall defect was repaired with a non-cross linked acellular dermal matrix (ADM) anchored to the thoracic wall. At a 6-year follow-up, she was asymptomatic and without recurrence of the hernia. Our experience suggests that ADMs are a safe and reliable surgical technique for lung hernia repair due to their biological and mechanical properties, even in those secondary hernias to minithoracotomy where a complete muscle coverage of the matrix could not be provided.

Keywords: Acellular dermal matrix; Chest wall reconstruction; Lung hernia; Minimally invasive valve surgery; Minithoracotomy; Strattice.

Fig. 1

Preoperative chest CT scan showing a right-sided intercostal lung hernia with retraction of the pectoralis major muscle (coronal view with 3D reconstruction).

Fig. 2

Intraoperative image of the hernia and pectoralis major retracted (A). The intercostal space diastasis was reduced with interrupted not-resorbable sutures, and a patch of StratticeTM was placed. The matrix was partially covered with the stretched pectoralis major muscle which was distally anchored to the ribs (B).

Fig. 3

One-year follow-up chest CT confirmed restoration of the hernia (coronal view with 3D reconstruction).