Pittman Troy A, Fan Kenneth L, Knapp Andrew, Frantz Shelby, Spear Scott L
Washington, D.C.
From the Department of Plastic Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and private practice.
Plast Reconstr Surg. 2017 Mar;139(3):521-528. doi: 10.1097/PRS.0000000000003048.
Acellular dermal matrix has enjoyed extensive use in primary and secondary alloplastic breast aesthetic and reconstructive surgery. The objective of this study was to examine clinical outcomes between available acellular dermal matrix products: DermACELL (LifeNet Health, Virginia Beach, Va.) and AlloDerm Ready To Use (LifeCell Corp., Branchburg, N.J.).
A retrospective chart review was performed on 58 consecutive patients (100 breasts) reconstructed with either DermACELL (n = 30 patients; 50 breasts) or AlloDerm Ready To Use (n = 28 patients; 50 breasts). The mastectomies were performed by three different breast surgeons. All reconstructions were performed by the same plastic surgeon (T.A.P.). Statistical analysis was performed by means of Fisher's exact test.
Differences in the average age, body mass index, percentage having neoadjuvant/adjuvant chemotherapy or breast irradiation, and numbers of therapeutic and prophylactic mastectomies between the two groups were not statistically significant (p < 0.05). Complications in both cohorts of patients were clinically recorded for 90 days after immediate reconstruction. When comparing outcomes, patients in the DermACELL group had a significantly lower incidence of "red breast syndrome" (0 percent versus 26 percent; p = 0.0001) and fewer days before drain removal (15.8 days versus 20.6 days; p = 0.017). No significant differences were seen in terms of seroma, hematoma, delayed healing, infection, flap necrosis, or explantation.
Patients reconstructed with DermACELL as compared with AlloDerm Ready To Use have significantly decreased number of days to drain removal and red breast syndrome and equivalent rates of other complications, including seroma, infection, flap necrosis, and explantation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
脱细胞真皮基质已广泛应用于一期和二期异体乳房美容及重建手术。本研究的目的是比较现有脱细胞真皮基质产品DermACELL(弗吉尼亚海滩市LifeNet Health公司)和即用型AlloDerm(新泽西州布兰奇堡市LifeCell公司)的临床效果。
对连续58例患者(100个乳房)进行回顾性病历分析,这些患者分别使用DermACELL(30例患者;50个乳房)或即用型AlloDerm(28例患者;50个乳房)进行乳房重建。乳房切除术由三位不同的乳腺外科医生实施。所有重建手术均由同一位整形外科医生(T.A.P.)完成。采用Fisher精确检验进行统计学分析。
两组患者在平均年龄、体重指数、接受新辅助/辅助化疗或乳房放疗的比例以及治疗性和预防性乳房切除术的数量方面差异无统计学意义(p<0.05)。即刻重建后90天内对两组患者的并发症进行临床记录。比较结果时,DermACELL组患者“红乳综合征”的发生率显著较低(0%对26%;p=0.0001),引流管拔除前的天数也较少(15.8天对20.6天;p=0.017)。在血清肿、血肿、愈合延迟、感染、皮瓣坏死或植入物取出方面未观察到显著差异。
与即用型AlloDerm相比,使用DermACELL进行乳房重建的患者引流管拔除天数和红乳综合征显著减少,其他并发症(包括血清肿、感染、皮瓣坏死和植入物取出)的发生率相当。
临床问题/证据水平:治疗性,III级