Comparative Effectiveness of Natural Versus Synthetic Biodegradable Scaffolds in Soft Tissue Reconstruction: A Systematic Review and Meta-Analysis

Biodegradable scaffolds are widely used in soft tissue reconstruction to support tissue regeneration and reduce long-term complications, yet the comparative clinical effectiveness of natural and synthetic scaffolds remains unclear. This systematic review and meta-analysis evaluated outcomes including recurrence rate, healing time, hospitalization duration, and complications. Following PRISMA guidelines and PROSPERO registration, PubMed, Scopus, and Web of Science were searched for studies published between January 2015 and January 2026. Randomized controlled trials and cohort studies involving human participants undergoing soft tissue reconstruction were included. Nine studies across multiple surgical fields were analyzed. Pooled results showed a significantly lower recurrence rate with natural scaffolds compared to synthetic scaffolds (RR 0.30, 95% CI 0.12 to 0.73, p = 0.008), with no heterogeneity (I² = 0%). Healing time did not differ significantly between groups (standard mean difference [SMD] -0.13, 95% CI -0.53 to 0.27, I² = 55%). Hospitalization time showed no significant difference but had high heterogeneity (SMD -0.76, 95% CI -0.06 to 1.57, I² = 89%). Complication rates favored natural scaffolds but were not statistically significant (RR 0.69, 95% CI 0.33 to 1.45, I² = 60%). Sensitivity analysis confirmed stability of findings. Natural scaffolds reduce recurrence and show a favorable safety trend, while healing and hospitalization outcomes depend more on surgical context than scaffold type.