Brooke Sebastian, Mesa John, Uluer Mehmet, Michelotti Brett, Moyer Kurtis, Neves Rogerio I, Mackay Donald, Potochny John
Division of Plastic Surgery, The Pennsylvania State University, College of Medicine, Penn State Milton S. Hershey Medicine Center, Hershey, PA 17033-0850, USA.
Ann Plast Surg. 2012 Oct;69(4):347-9. doi: 10.1097/SAP.0b013e31824b3d97.
Acellular dermal matrix (ADM) is frequently used in tissue expander breast reconstruction (TEBR) for coverage of the inferior pole. Several published studies have suggested increased rates of complications with the use of ADM. It is unknown, however, if the type of ADM used for TEBR impacts complication rates. The aim of this study is to compare 3 different types of ADM for TEBR in regard to clinically significant complications, specifically infection. We performed a retrospective analysis of primary breast cancer-related TEBR with or without ADM. Exclusion criteria consisted of prior major breast surgery, inadequate data, or loss to follow-up. Reconstructions were grouped by dermal sling type, AlloDerm, DermaMatrix (DM), FlexHD (FHD), or no ADM. Complications included cellulitis, abscess, seroma, expander leak or puncture, skin necrosis, wound dehiscence, or hematoma. Those requiring admission to hospital or reoperation were considered significant. Of 284 breasts reconstructed, 49 used AlloDerm, 110 used DM, 62 used FHD, and 64 used no ADM. The total complication rate with AlloDerm was 22% [95% confidence interval (CI), 11-34], with DM was 15% (95% CI, 8-21), and with FHD was 18% (95% CI, 8-28) (P=0.47). Infectious complication rates for AlloDerm, DM, and FHD were equal at 10% (P=0.97). The total complication rate of all ADM reconstructions as a grouped cohort was 17% compared to 11% without ADM (P=0.48). The overall incidence of infectious complications with ADM was 10% compared to 2% without ADM (P=0.09). There is no difference in the clinically significant overall complication rate or incidence of infection between AlloDerm, DM, and FHD. Isolating infectious complications, there is a trend toward increased incidence with ADM compared to reconstructions without.
脱细胞真皮基质（ADM）常用于组织扩张器乳房重建（TEBR）以覆盖乳房下极。多项已发表的研究表明，使用ADM会增加并发症发生率。然而，用于TEBR的ADM类型是否会影响并发症发生率尚不清楚。本研究的目的是比较3种不同类型的ADM用于TEBR时在临床上显著的并发症，特别是感染方面的情况。我们对有或没有使用ADM的原发性乳腺癌相关TEBR进行了回顾性分析。排除标准包括既往重大乳房手术、数据不充分或失访。重建手术根据真皮吊带类型进行分组，即使用AlloDerm、DermaMatrix（DM）、FlexHD（FHD）或不使用ADM。并发症包括蜂窝织炎、脓肿、血清肿、扩张器渗漏或穿刺、皮肤坏死、伤口裂开或血肿。那些需要住院或再次手术的情况被视为严重并发症。在284例乳房重建病例中，49例使用AlloDerm，110例使用DM，62例使用FHD，64例未使用ADM。使用AlloDerm的总并发症发生率为22%[95%置信区间（CI），11 - 34]，使用DM的为15%（95%CI，8 - 21），使用FHD的为18%（95%CI，8 - 28）（P = 0.47）。AlloDerm、DM和FHD的感染性并发症发生率均为10%（P = 0.97）。所有使用ADM重建病例作为一个分组队列的总并发症发生率为17%，而未使用ADM的为11%（P = 0.48）。使用ADM的感染性并发症总体发生率为10%，未使用ADM的为2%（P = 0.09）。AlloDerm、DM和FHD在临床上显著的总体并发症发生率或感染发生率方面没有差异。单独来看感染性并发症，与未使用ADM的重建手术相比，使用ADM的发生率有增加的趋势。
