Vu Michael M, De Oliveira Gildasio S, Mayer Kristen E, Blough Jordan T, Kim John Y S
Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2016 Jan 7;3(12):e585. doi: 10.1097/GOX.0000000000000574. eCollection 2015 Dec.
The value proposition of an acellular dermal matrix (ADM) taken from the deep dermis is that the allograft may be more porous, allowing for enhanced integration and revascularization. In turn, this characteristic may attenuate complications related to foreign body reactions, seromas, and infection. However, this is juxtaposed against the potential loss of allograft structural integrity, with subsequent risk of malposition and extrusion. Despite the active use of novel, deep dermal ADMs, the clinical outcomes of this new technology has not been well studied.
This is a prospective study to evaluate surgical and patient-reported outcomes using a deep dermal ADM, FlexHD Pliable. Surgical outcomes and BREAST-Q patient-reported outcomes were evaluated postoperatively at 2- and 6-month time points.
Seventy-two breasts (41 patients) underwent reconstruction. Complication rate was 12.5%, including 2 hematomas and 7 flap necroses. One case of flap necrosis led to reconstructive failure. Notably, there were no cases of infection, seroma, or implant extrusion or malposition. Average BREAST-Q scores were satisfaction with outcome (70.13 ± 23.87), satisfaction with breasts (58.53 ± 20.00), psychosocial well being (67.97 ± 20.93), sexual well being (54.11 ± 27.72), and physical well being (70.45 ± 15.44). Two-month postoperative BREAST-Q scores decreased compared with baseline and returned to baseline by 6 months. Postoperative radiation therapy had a negative effect on satisfaction with breasts (P = 0.004) and sexual well being (P = 0.006).
Deep dermal ADM is a novel modification of traditional allograft technology. Use of the deep dermal ADM yielded acceptably low complication rates and satisfactory patient-reported outcomes.
取自深层真皮的脱细胞真皮基质（ADM）的价值主张在于，同种异体移植物可能具有更多孔隙，有利于增强整合和血管再生。相应地，这一特性可能减轻与异物反应、血清肿和感染相关的并发症。然而，这与同种异体移植物结构完整性的潜在丧失形成对比，随之存在移位和挤出的风险。尽管新型深层真皮ADM得到了积极应用，但这项新技术的临床结果尚未得到充分研究。
这是一项前瞻性研究，旨在使用深层真皮ADM（FlexHD Pliable）评估手术和患者报告的结果。在术后2个月和6个月时间点评估手术结果和BREAST-Q患者报告的结果。
72个乳房（41例患者）接受了重建。并发症发生率为12.5%，包括2例血肿和7例皮瓣坏死。1例皮瓣坏死导致重建失败。值得注意的是，没有感染、血清肿或植入物挤出或移位的病例。BREAST-Q平均得分如下：对结果的满意度（70.13±23.87）、对乳房的满意度（58.53±20.00）、心理社会幸福感（67.97±20.93）、性幸福感（54.11±27.72）和身体幸福感（70.45±15.44）。术后2个月的BREAST-Q得分与基线相比下降，并在6个月时恢复到基线水平。术后放疗对乳房满意度（P = 0.004）和性幸福感（P = 0.006）有负面影响。
深层真皮ADM是传统同种异体移植技术的一种新型改良。使用深层真皮ADM产生的并发症发生率低至可接受水平，且患者报告的结果令人满意。
