Nottingham, Doncaster, and Chesterfield, United Kingdom.
From the Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, City Hospital; the Department of Breast Surgery, Doncaster & Bassetlaw Hospitals NHS Foundation Trust, Doncaster Royal Infirmary; and the Department of Breast Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield Royal Hospital.
Plast Reconstr Surg. 2018 Feb;141(2):283-293. doi: 10.1097/PRS.0000000000004018.
BACKGROUND: Strattice (porcine derivative) and SurgiMend (bovine derivative) are the two most common acellular dermal matrices used in breast reconstruction in the United Kingdom. This retrospective study compared clinical outcomes in immediate implant-based breast reconstruction patients. METHODS: The study, conducted across three hospitals, included all patients who underwent immediate implant-based breast reconstruction using Strattice and SurgiMend. The primary outcome measure was implant loss rate. Secondary outcome measures included acellular dermal matrix loss rate, seroma formation, and minor and major complication rates. Intergroup comparison was performed. RESULTS: Eighty-two patients (Strattice, n = 45; SurgiMend, n = 37) underwent 97 immediate implant-based breast reconstructions (Strattice, n = 54; SurgiMend, n = 43). There were no differences between groups for age, comorbidities, specimen weight, or implant volume. Drains were used in all Strattice and 36 (84 percent) SurgiMend cases. The implant loss rate was higher for Strattice (n = 10, 20 percent) compared with SurgiMend (n = 3, 7 percent) but failed to reach statistical significance (chi-square test, p = 0.077). The acellular dermal matrix loss rate was significantly higher (Fisher's exact test, p = 0.014) in the Strattice group (n = 7, 14 percent), with no acellular dermal matrix loss with SurgiMend. The reoperation rate was also significantly higher (chi-square test, p = 0.002) in the Strattice group (n = 17, 33 percent, versus n = 3, 7 percent). The incidence of red breast was significantly higher (chi-square test, p = 0.022) in the SurgiMend group (n = 9, 21 percent, versus n = 3, 6 percent). Seroma, wound problems, and infection rates were similar. CONCLUSIONS: Clinical outcomes, including implant loss, acellular dermal matrix loss, and reoperation rates, are significantly better when using SurgiMend in immediate implant-based breast reconstruction compared with Strattice. An appropriately powered randomized trial is needed to provide further information. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景：Strattice（猪源性）和 SurgiMend（牛源性）是英国乳房重建中最常用的两种去细胞真皮基质。这项回顾性研究比较了即刻植入物乳房重建患者的临床结果。
方法：该研究在三家医院进行，纳入所有使用 Strattice 和 SurgiMend 进行即刻植入物乳房重建的患者。主要结局指标是植入物丢失率。次要结局指标包括去细胞真皮基质丢失率、血清肿形成、轻微和主要并发症发生率。进行了组间比较。
结果：82 例患者（Strattice 组 45 例；SurgiMend 组 37 例）接受了 97 例即刻植入物乳房重建（Strattice 组 54 例；SurgiMend 组 43 例）。两组间年龄、合并症、标本重量或植入物体积无差异。所有 Strattice 组和 36 例（84%）SurgiMend 组均使用引流管。Strattice 组的植入物丢失率（n=10，20%）高于 SurgiMend 组（n=3，7%），但未达到统计学意义（卡方检验，p=0.077）。Strattice 组的去细胞真皮基质丢失率明显更高（Fisher 确切检验，p=0.014）（n=7，14%），而 SurgiMend 组无去细胞真皮基质丢失。Strattice 组的再次手术率也明显更高（卡方检验，p=0.002）（n=17，33%，vs SurgiMend 组 n=3，7%）。 SurgiMend 组红乳房的发生率明显更高（卡方检验，p=0.022）（n=9，21%，vs 3 例，6%）。血清肿、伤口问题和感染率相似。
结论：与 Strattice 相比，在即刻植入物乳房重建中使用 SurgiMend 可显著改善临床结局，包括植入物丢失、去细胞真皮基质丢失和再次手术率。需要进行适当的随机对照试验以提供更多信息。
临床问题/证据水平：治疗性，III 级。
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