Rawlani Vinay, Buck Donald W, Johnson Sarah A, Heyer Kamaldeep S, Kim John Y S
Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
Ann Plast Surg. 2011 Jun;66(6):593-7. doi: 10.1097/SAP.0b013e3181f3ed0a.
Human acellular dermal matrices help facilitate immediate tissue expander-implant breast reconstruction by providing support to the inferolateral pole, improving control of implant position, and enhancing early volume expansion. Although several freeze-dried human acellular dermal products have demonstrated reasonable safety and efficacy in immediate tissue expander-implant breast reconstruction, no dedicated studies have evaluated clinical outcomes of prehydrated human acellular dermal matrix (PHADM) in breast reconstruction.
The outcomes of 121 consecutive tissue expander reconstructions performed by the senior author using PHADM were evaluated.
Mean intraoperative tissue expander fill volume was 256.6 ± 133 mL, 60% of final expander volume. Patients required an average of 3.2 additional expansions prior to tissue expander-to-implant exchange. Mean follow-up period after reconstruction was 44 ± 26.5 weeks. Complications occurred in 20 (16.5%) breasts, including 9 (7.4%) soft-tissue infections, 8 (6.6%) partial mastectomy flap necroses, and 2 (1.7%) seromas. Eleven (9.1%) breasts ultimately required explantation. Patients receiving radiation demonstrated a strong trend toward greater complications (30.8% vs. 13.7%, P = 0.0749).
The outcomes and complication rates of PHADM tissue expander breast reconstruction are comparable to those reported with freeze-dried human acellular dermis.
人脱细胞真皮基质通过为乳房下外侧极提供支撑、改善对植入物位置的控制以及增强早期容积扩张，有助于促进即时组织扩张器植入式乳房重建。尽管几种冻干人脱细胞真皮产品在即时组织扩张器植入式乳房重建中已显示出合理的安全性和有效性，但尚无专门研究评估预水化人脱细胞真皮基质（PHADM）在乳房重建中的临床结果。
对资深作者使用PHADM进行的连续121例组织扩张器重建的结果进行评估。
术中组织扩张器平均填充容积为256.6±133 mL，占最终扩张器容积的60%。在组织扩张器更换为植入物之前，患者平均需要额外进行3.2次扩张。重建后的平均随访期为44±26.5周。20例（16.5%）乳房出现并发症，包括9例（7.4%）软组织感染、8例（6.6%）部分乳房切除皮瓣坏死和2例（1.7%）血清肿。11例（9.1%）乳房最终需要取出植入物。接受放疗的患者出现并发症的趋势更为明显（30.8%对13.7%，P = 0.0749）。
PHADM组织扩张器乳房重建的结果和并发症发生率与冻干人脱细胞真皮报道的结果相当。
