Davis Claire, Boyd Carter, Mateo de Acosta Andino David A, Kumbla Pallavi A, Sanchez Ruston J, Kurapati Srikanth, King Timothy W, de la Torre Jorge I
From the UAB School of Medicine.
UAB Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL.
Ann Plast Surg. 2020 May;84(5):618-622. doi: 10.1097/SAP.0000000000002128.
Breast cancer affects 1 in 8 women. As the treatment of breast cancer evolves, breast reconstruction does as well. Implant-based reconstructions are increasing, leading to increased use of acellular dermal matrix (ADM) for better implant positioning. Acellular dermal matrices are derived from cadaveric skin and are processed to be immunologically inert. However, ADM can be costly and can have complications such as seroma and infection. This has led to the development of dermal autografts. These were first used in postmastectomy breast reconstruction in women with redundant breast skin that was deepithelialized and used for lower pole coverage of tissue expanders and implants. This evolved into harvesting dermal autografts from the abdomen. Later studies evaluated the use of meshed dermal autografts. Histological analysis of ADM versus dermal autografts shows that there are increased vessels within dermal autografts compared with ADM. This potentially contributes to the decreased complication rate seen with autografts. In addition, one study showed equivalent results in aesthetic outcomes and capsular contracture between ADM and dermal autograft. Analysis of cost has shown that ADM is significantly more costly than harvesting a dermal autograft. Physician reimbursement is also higher for dermal autografts. This review article seeks to summarize key studies that highlight the feasibility of using dermal autografts in breast reconstruction.
八分之一的女性会患乳腺癌。随着乳腺癌治疗方法的不断发展，乳房重建技术也在进步。基于植入物的重建手术越来越多，这导致脱细胞真皮基质（ADM）的使用增加，以实现更好的植入物定位。脱细胞真皮基质来源于尸体皮肤，经过处理后具有免疫惰性。然而，ADM成本高昂，且可能引发血清肿和感染等并发症。这促使了自体真皮移植的发展。自体真皮移植最初用于乳房切除术后乳房重建，适用于有多余乳房皮肤的女性，将其进行去上皮化处理后用于组织扩张器和植入物的下极覆盖。后来发展为从腹部获取自体真皮移植。随后的研究评估了网状自体真皮移植的使用。对ADM和自体真皮移植的组织学分析表明，与ADM相比，自体真皮移植内的血管更多。这可能是自体真皮移植并发症发生率较低的原因。此外，一项研究表明，ADM和自体真皮移植在美学效果和包膜挛缩方面的结果相当。成本分析显示，ADM的成本明显高于获取自体真皮移植。医生对自体真皮移植的报销费用也更高。这篇综述文章旨在总结一些关键研究，这些研究突出了在乳房重建中使用自体真皮移植的可行性。
