From the Shaare Zedek Medical Center; The Hebrew University of Jerusalem; Assuta Medical Center; and Kaplan Medical Center.
Plast Reconstr Surg. 2019 Nov;144(5):1045-1053. doi: 10.1097/PRS.0000000000006116.
Acellular dermal matrices are commonly used to support implant-based breast reconstruction. Meshing may enhance integration, reduce drain time and seroma, and decrease surgical costs.
This was a retrospective, single-center analysis of 83 adult women (115 breasts) undergoing one-stage (84.3 percent) or two-stage (15.7 percent) immediate breast reconstruction with bovine-derived acellular dermal matrix (SurgiMend) meshed at a 2:1 ratio. Outcomes were compared with previously published data from a control group of 111 patients (147 breasts) undergoing the same procedure with nonmeshed (fenestrated) acellular dermal matrix.
The mean age of patients receiving meshed acellular dermal matrix was 48.3 years and the mean body mass index was 23.6 kg/m. There were no significant differences in baseline characteristics versus controls, other than chemotherapy history (received by fewer patients in the meshed acellular dermal matrix group). Mean follow-up was 23.6 months. Overall rates of minor and major complications in the meshed acellular dermal matrix group were 16.5 percent and 13.0 percent, respectively-similar to controls (25.2 percent and 12.9 percent). However, with meshed acellular dermal matrix, there were significantly fewer major seromas (0 percent versus 8.2 percent; OR, ∞; 95 percent CI, 1.927 to ∞), fewer total hematomas (0 percent versus 4.8 percent; OR, ∞; 95 percent CI, 1.022 to ∞), and fewer total infections (10.4 percent versus 23.8 percent; OR, 2.682; 95 percent CI, 1.259 to 5.802) compared with controls. Time to drain removal was reduced. Rates of capsular contracture (5.2 percent versus 2.7 percent) and explantation (5.2 percent versus 2.7 percent) were similar in the meshed acellular dermal matrix and control groups.
Acellular dermal matrix meshing reduces rates of postoperative seroma, hematoma, and infection and decreases drain removal time compared with nonmeshed acellular dermal matrix.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
脱细胞真皮基质常用于支持基于植入物的乳房重建。网孔化可以增强整合，减少引流时间和血清肿，降低手术成本。
这是一项回顾性、单中心分析，纳入 83 名接受牛源脱细胞真皮基质（SurgiMend）网状物 2:1 比例的一期（84.3%）或二期（15.7%）即刻乳房重建的成年女性（115 个乳房）。结果与接受相同程序但未进行网状（有孔）脱细胞真皮基质的 111 名患者（147 个乳房）的对照组的先前发表数据进行了比较。
接受网状脱细胞真皮基质的患者平均年龄为 48.3 岁，平均体重指数为 23.6kg/m²。除化疗史（网状脱细胞真皮基质组接受化疗的患者较少）外，两组患者的基线特征无显著差异。平均随访时间为 23.6 个月。网状脱细胞真皮基质组的小并发症和大并发症发生率分别为 16.5%和 13.0%，与对照组相似（25.2%和 12.9%）。然而，网状脱细胞真皮基质组的大血清肿发生率显著较低（0%比 8.2%；OR，∞；95%CI，1.927 至 ∞），总血肿发生率较低（0%比 4.8%；OR，∞；95%CI，1.022 至 ∞），总感染率较低（10.4%比 23.8%；OR，2.682；95%CI，1.259 至 5.802）。引流管去除时间缩短。网状脱细胞真皮基质组和对照组的包膜挛缩（5.2%比 2.7%）和假体取出（5.2%比 2.7%）发生率相似。
与非网状脱细胞真皮基质相比，脱细胞真皮基质网孔化可降低术后血清肿、血肿和感染的发生率，并缩短引流管去除时间。
临床问题/证据水平：治疗性，III 级。
