Cabalag Miguel S, Rostek Marie, Miller George S, Chae Michael P, Quinn Tam, Rozen Warren M, Hunter-Smith David J
1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia.
Gland Surg. 2016 Apr;5(2):158-73. doi: 10.3978/j.issn.2227-684X.2015.06.02.
There has been an increasing role of acellular dermal matrices (ADMs) and synthetic meshes in both single- and two-stage implant/expander breast reconstruction. Numerous alloplastic adjuncts exist, and these vary in material type, processing, storage, surgical preparation, level of sterility, available sizes and cost. However, there is little published data on most, posing a significant challenge to the reconstructive surgeon trying to compare and select the most suitable product. The aims of this systematic review were to identify, summarize and evaluate the outcomes of studies describing the use of alloplastic adjuncts for post-mastectomy breast reconstruction. The secondary aims were to determine their cost-effectiveness and analyze outcomes in patients who also underwent radiotherapy.
Using the PRSIMA 2009 statement, a systematic review was conducted to find articles reporting on the outcomes on the use of alloplastic adjuncts in post-mastectomy breast reconstruction. Multiple databases were searched independently by three authors (Cabalag MS, Miller GS and Chae MP), including: Ovid MEDLINE (1950 to present), Embase (1980 to 2015), PubMed and Cochrane Database of Systematic Reviews.
Current published literature on available alloplastic adjuncts are predominantly centered on ADMs, both allogeneic and xenogeneic, with few outcome studies available for synthetic meshes. Outcomes on the 89 articles, which met the inclusion criteria, were summarized and analyzed. The reported outcomes on alloplastic adjunct-assisted breast reconstruction were varied, with most data available on the use of ADMs, particularly AlloDerm(®) (LifeCell, Branchburg, New Jersey, USA). The use of ADMs in single-stage direct-to-implant breast reconstruction resulted in lower complication rates (infection, seroma, implant loss and late revision), and was more cost effective when compared to non-ADM, two-stage reconstruction. The majority of studies demonstrated inferior outcomes in ADM assisted, two-stage expander-to-implant reconstruction compared to non-ADM use. Multiple studies suggest that the use of ADMs results in a reduction of capsular contracture rates. Additionally, the reported beneficial effects of ADM use in irradiated tissue were varied.
ADM assisted two-stage breast reconstruction was associated with inferior outcomes when compared to non-ADM use. However, alloplastic adjuncts may have a role in single stage, direct-to-implant breast reconstruction. Published evidence comparing the long-term outcomes between the different types of adjuncts is lacking, and further level one studies are required to identify the ideal product.
脱细胞真皮基质（ADM）和合成网片在一期和二期植入物/扩张器乳房重建中的作用日益增加。存在多种异体材料辅助物，它们在材料类型、加工、储存、手术准备、无菌水平、可用尺寸和成本方面各不相同。然而，关于大多数辅助物的公开数据很少，这给试图比较和选择最合适产品的重建外科医生带来了重大挑战。本系统评价的目的是识别、总结和评估描述异体材料辅助物用于乳房切除术后乳房重建的研究结果。次要目的是确定其成本效益，并分析同时接受放疗的患者的结果。
根据PRISMA 2009声明进行系统评价，以查找报告异体材料辅助物用于乳房切除术后乳房重建结果的文章。由三位作者（Cabalag MS、Miller GS和Chae MP）独立检索多个数据库，包括：Ovid MEDLINE（1950年至今）、Embase（1980年至2015年）、PubMed和Cochrane系统评价数据库。
目前关于可用异体材料辅助物的已发表文献主要集中在同种异体和异种的ADM上，关于合成网片的结果研究很少。对符合纳入标准的89篇文章的结果进行了总结和分析。报道的异体材料辅助物辅助乳房重建的结果各不相同，关于ADM使用的数据最多，特别是AlloDerm®（美国新泽西州布兰奇堡的LifeCell公司）。在一期直接植入式乳房重建中使用ADM导致并发症发生率较低（感染、血清肿、植入物丢失和后期翻修），与非ADM的二期重建相比更具成本效益。大多数研究表明，与不使用ADM相比，ADM辅助的二期扩张器到植入物重建的结果较差。多项研究表明，使用ADM可降低包膜挛缩率。此外，关于在受照射组织中使用ADM的报道的有益效果各不相同。
与不使用ADM相比，ADM辅助的二期乳房重建结果较差。然而，异体材料辅助物可能在一期直接植入式乳房重建中发挥作用。缺乏比较不同类型辅助物长期结果的已发表证据，需要进一步的一级研究来确定理想的产品。
