Cincinnati, Ohio From the Christ Hospital.
Plast Reconstr Surg. 2013 May;131(5):940-951. doi: 10.1097/PRS.0b013e3182865ab3.
A 2010 nationwide survey of plastic and reconstructive surgeons indicated that approximately 83 percent performed predominantly implant-based breast reconstruction, with acellular dermal matrix used by approximately half of those practitioners. Although the medical literature documents well over 2000 cases of breast reconstruction with matrices, relatively few cases using other than human cadaveric acellular dermal matrices have been reported. The author compared complications and costs using SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices.
A retrospective review of a single surgeon's 5-year experience was performed for consecutive, nonrandomized immediate breast reconstructions with acellular dermal matrix from 2005 to 2010.
Two hundred eighty-one patients had 440 implant-based reconstructions using SurgiMend [222 patients (79.0 percent)] or AlloDerm [59 patients (21.0 percent)]. No significant differences in complication rates were observed between SurgiMend and AlloDerm for hematoma, infection, major skin necrosis, or breast implant removal. Seroma was the most prevalent complication; the seroma rate for AlloDerm (15.7 percent) was significantly greater than that for SurgiMend (8.3 percent). Using recent product costs for equivalently sized AlloDerm and SurgiMend units, the cost of SurgiMend was $1024 less per breast than AlloDerm.
SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices demonstrate similar rates of major early complications in breast reconstruction in this study. This similarity in complication rates between SurgiMend and AlloDerm and the cost savings seen with the use of SurgiMend are factors for the surgeon to consider in choosing a matrix for breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, III.
2010 年全国范围内对整形和重建外科医生的调查表明，约 83%的医生主要进行基于植入物的乳房重建，其中约一半的医生使用去细胞真皮基质。尽管医学文献记录了超过 2000 例使用基质的乳房重建病例，但使用除人类尸体去细胞真皮基质以外的其他基质的病例相对较少。作者比较了使用 SurgiMend 胎牛和 AlloDerm 人类尸体去细胞真皮基质的并发症和成本。
对 2005 年至 2010 年间连续非随机即刻乳房重建中使用去细胞真皮基质的一位外科医生的 5 年经验进行回顾性分析。
281 例患者进行了 440 例基于植入物的重建，其中 222 例（79.0%）使用 SurgiMend，59 例（21.0%）使用 AlloDerm。SurgiMend 和 AlloDerm 在血肿、感染、大面积皮肤坏死或乳房植入物取出方面的并发症发生率无显著差异。血清肿是最常见的并发症；AlloDerm 的血清肿发生率（15.7%）明显高于 SurgiMend（8.3%）。使用最近的同种尺寸 AlloDerm 和 SurgiMend 单位的产品成本，SurgiMend 的每侧乳房成本比 AlloDerm 低 1024 美元。
在本研究中，SurgiMend 胎牛和 AlloDerm 人类尸体去细胞真皮基质在乳房重建中表现出相似的早期主要并发症发生率。SurgiMend 和 AlloDerm 之间在并发症发生率方面的相似性以及使用 SurgiMend 带来的成本节约是外科医生在选择乳房重建基质时需要考虑的因素。
临床问题/证据水平：治疗性，III 级。
