Ball Jessica F, Sheena Yezen, Tarek Saleh Dina M, Forouhi Parto, Benyon Sarah L, Irwin Michael S, Malata Charles M
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
J Plast Reconstr Aesthet Surg. 2017 Aug;70(8):1076-1082. doi: 10.1016/j.bjps.2017.05.015. Epub 2017 May 19.
Acellular dermal matrix (ADM) assisted implant-based breast reconstruction (IBBR) has grown in popularity over traditional submuscular techniques. Numerous human, bovine or porcine derived ADMs are available with the type used varying considerably worldwide. Yet, comparative evidence for the efficacy of different ADMs particularly xenogenic is limited. This study directly compares early outcomes of porcine (Strattice™) and bovine (Surgimend™) ADMs in IBBR.
Retrospective study of sequential experience of immediate IBBR using Strattice or Surgimend ADM. Data was collected for patients undergoing ADM assisted IBBR after prophylactic or therapeutic mastectomy in Cambridge (October 2011-March 2016). Patient demographics, adjuvant and neoadjuvant therapies, operative details, postoperative management and outcomes were analysed.
Total of 81 patients underwent IBBR with ADM; 38 bilateral and 43 unilateral (n = 119 breasts). Strattice was used in 30 breasts (25%) and Surgimend in 89 (75%). Analysis of patient specific variables showed statistical significance only for higher mastectomy weight in the Strattice group (367.1 ± 159.3 g versus 296.3 ± 133.4 g; P = 0.0379). Strattice was associated with higher rates of skin erythema post-operatively (16.7% versus 4.5%; P = 0.044). Analysed per woman or per breast, there was no statistically significant difference in rates of haematoma, infection, wound dehiscence, skin necrosis or seroma, although there was a trend towards more complications with Strattice.
This study found significantly higher rates of skin erythema and a trend towards higher complication rates with Strattice in IBBR. Randomised controlled trials comparing different ADM outcomes are needed to inform best practice.
与传统的胸大肌下技术相比，脱细胞真皮基质（ADM）辅助的植入式乳房重建术（IBBR）越来越受欢迎。目前有多种来源的ADM可供使用，包括人源、牛源或猪源，且世界各地使用的类型差异很大。然而，关于不同ADM，尤其是异种来源ADM疗效的比较证据有限。本研究直接比较了猪源（Strattice™）和牛源（Surgimend™）ADM在IBBR中的早期结果。
对使用Strattice或Surgimend ADM进行即刻IBBR的连续病例进行回顾性研究。收集了2011年10月至2016年3月在剑桥接受预防性或治疗性乳房切除术后ADM辅助IBBR患者的数据。分析了患者的人口统计学特征、辅助和新辅助治疗、手术细节、术后管理及结果。
共有81例患者接受了ADM辅助的IBBR；其中38例为双侧，43例为单侧（共119个乳房）。30个乳房（25%）使用了Strattice，89个乳房（75%）使用了Surgimend。对患者特定变量的分析显示，仅Strattice组的乳房切除重量更高具有统计学意义（367.1±159.3克对296.3±133.4克；P = 0.0379）。Strattice术后皮肤红斑发生率更高（16.7%对4.5%；P = 0.044）。按每位女性或每个乳房分析，血肿、感染、伤口裂开、皮肤坏死或血清肿的发生率无统计学显著差异，尽管Strattice有出现更多并发症的趋势。
本研究发现，在IBBR中，Strattice的皮肤红斑发生率显著更高，且有并发症发生率更高的趋势。需要进行比较不同ADM结果的随机对照试验，以指导最佳实践。
