Hybrid chest wall reconstruction using a composite scaffold and mesh: a surgical technique

Chest wall reconstruction after oncologic resection or for congenital defects such as Poland syndrome poses significant technical challenges. Available reconstructive options present distinct limitations: synthetic meshes provide immediate mechanical support but are biologically inert, rigid prostheses carry higher infection risk and limited adaptability, and biologic matrices may lack early structural rigidity. Here, we describe a hybrid reconstruction technique that combines a double-layer Marlex^® mesh (Davol Inc., Cranston, RI, USA) with a Vitagraft^® bioactive scaffold (DMC Equipamentos, São Carlos, SP, Brazil)-composed of β-tricalcium phosphate and poly-L-lactic acid. The technique was initially developed for Poland syndrome and is equally applicable to oncologic full-thickness chest wall resections. The Marlex mesh is shaped to the defect and anchored circumferentially to the rib margins with nonabsorbable interrupted sutures, providing immediate mechanical stability. Vitagraft blocks are softened in sterile water at 70 ℃, custom-molded to the defect-with the possibility of reheating two to three times for progressive adjustment-and fixed over the mesh using the same cardinal sutures. Direct scaffold-to-rib-bone-edge contact (avoiding costal cartilage) is essential to promote osteoconductive integration and biological incorporation. The reconstruction is covered with a vascularized muscle flap, typically pectoralis major or serratus anterior, followed by layered closure over submuscular drains. In congenital cases with muscle aplasia, subcutaneous tissue may be used for coverage. Institutional experience confirms reproducible and safe results after overcoming the initial learning curve. This hybrid technique offers an anatomically adaptable, biologically active solution for complex chest wall defects across oncologic and congenital indications, combining the mechanical strength of Marlex mesh with the osteoconductive potential of the Vitagraft scaffold.