Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Biomed Res Int. 2021 Nov 16;2021:8101009. doi: 10.1155/2021/8101009. eCollection 2021.
The acellular dermal matrix plays an important role in reinforcing thin mastectomy skin and repositioning the implant in prosthetic breast reconstruction. As the concept of prepectoral plane has become widespread, the role of the acellular dermal matrix has become increasingly important. However, evidences and standards for appropriate thickness and direction during placement remain insufficient. This study is aimed at testing the assumption that differences in the acellular dermal matrix thickness and orientation during placement may affect surgical outcomes including the incidence of postoperative complications.
This was a retrospective single-centered analysis of 43 patients (50 breasts) who underwent implant-based reconstruction with MegaDerm® (L&C Bio, Seoul, Korea) and 23 patients (23 breasts) who underwent implant-based reconstruction with DermACELL® (LifeNet Health, Virginia Beach, VA, USA), two types of human-derived acellular dermal matrix. All surgeries were performed by a single surgeon. Demographic variables, surgery-related factors, and complications were compared between a thick matrix group (1.5-2.3 mm) and a thin matrix group (1.0-1.5 mm). The same processes were performed in the nonreverse and reverse matrix insertion groups.
Baseline demographics and surgery-related data were summarized according to matrix thickness and direction. There were no significant intergroup differences in the demographic variables such as history of smoking, radiation, or chemotherapy. The mean drain volume was significantly higher in the thick matrix group than that in the thin matrix group ( = 0.0445). However, there were no significant differences in overall complication rates by matrix thickness ( = 0.3139). Additionally, there were no significant differences in complications between the nonreverse and reverse matrix insertion groups ( = 0.538).
Our findings suggest that patients with a thick acellular dermal matrix need a prolonged period for engraftment. However, the thickness did not directly affect the surgical outcomes between the thick and thin matrix groups. Likewise, the orientation in which the acellular dermal matrix was inserted did not affect the surgical outcomes including postoperative complications.
脱细胞真皮基质在加强薄型乳房切除术皮肤和重新定位假体乳房重建中的植入物方面发挥着重要作用。随着胸肌前平面概念的普及，脱细胞真皮基质的作用变得越来越重要。然而，在放置过程中适当的厚度和方向的证据和标准仍然不足。本研究旨在检验以下假设，即放置过程中脱细胞真皮基质的厚度和方向的差异可能会影响手术结果，包括术后并发症的发生率。
这是一项对 43 名患者（50 只乳房）进行的回顾性单中心分析，这些患者接受了基于植入物的重建，使用的是 MegaDerm®（韩国首尔的 L&C Bio），以及 23 名患者（23 只乳房）接受了基于植入物的重建，使用的是 DermACELL®（弗吉尼亚海滩的 LifeNet Health，VA，美国），这两种都是人体衍生的脱细胞真皮基质。所有手术均由同一位外科医生完成。比较厚基质组（1.5-2.3mm）和薄基质组（1.0-1.5mm）之间的人口统计学变量、手术相关因素和并发症。在非反转和反转基质插入组中进行了相同的过程。
根据基质厚度和方向总结了基线人口统计学和手术相关数据。在吸烟、放疗或化疗史等人口统计学变量方面，各组间无显著差异。厚基质组的平均引流量明显高于薄基质组（ = 0.0445）。然而，基质厚度对总并发症发生率无显著差异（ = 0.3139）。此外，非反转和反转基质插入组之间的并发症无显著差异（ = 0.538）。
我们的研究结果表明，厚脱细胞真皮基质的患者需要更长的时间进行植入。然而，厚度并没有直接影响厚基质组和薄基质组之间的手术结果。同样，脱细胞真皮基质插入的方向也不会影响手术结果，包括术后并发症。
