From the Division of Plastic and Reconstructive Surgery, Department of Surgery, the Division of Epidemiology, Department of Internal Medicine, and the Department of Pathology, University of Utah School of Medicine; and the Fred Hutch Cancer Center, University of Washington.
Plast Reconstr Surg. 2022 Mar 1;149(3):378e-385e. doi: 10.1097/PRS.0000000000008824.
The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a single-center, blinded, prospective, randomized, controlled trial established to compare outcomes using two popular types of acellular dermal matrices, AlloDerm and DermaMatrix, in tissue expander breast reconstruction. This study used the acellular dermal matrix biopsy specimens from the trial to evaluate how adjuvant therapy influences inflammation, neovascularization, and capsule formation of the acellular dermal matrix.
Punch biopsy specimens were taken at the time of expander exchange and were analyzed by a blinded pathologist. The inflammatory response was quantified by the number of fibroblasts, giant cells, and lymphocytes. Neovascularization and capsule formation were similarly quantified by the number of new capillaries and capsule presence and thickness, respectively.
Histology specimens were collected from 109 patients (170 breasts). In the absence of adjuvant therapy, there was no significant difference between AlloDerm and DermaMatrix in terms of inflammation, neovascularization, or capsule thickness. Both acellular dermal matrices showed a significant decrease in inflammation and neovascularization with adjuvant therapy. When chemotherapy and radiation therapy were used, the decrease in inflammation was greatest for the group reconstructed with DermaMatrix (p < 0.039).
Adjuvant therapy influences the inflammatory response, neovascularization, and capsule formation in both acellular dermal matrices. Adjuvant therapy has a protective effect on the inflammatory response toward both acellular dermal matrices in breast reconstruction. In the setting of chemotherapy and radiation therapy, DermaMatrix produced the greatest reduction in inflammation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
脱细胞真皮基质作为吊带在乳房再造中的应用评估试验是一项单中心、盲法、前瞻性、随机对照试验，旨在比较两种常用的脱细胞真皮基质（AlloDerm 和 DermaMatrix）在组织扩张器乳房再造中的效果。本研究使用该试验中的脱细胞真皮基质活检标本，评估辅助治疗如何影响脱细胞真皮基质的炎症、新生血管形成和包膜形成。
在扩张器更换时取穿刺活检标本，并由盲法病理学家进行分析。通过成纤维细胞、巨细胞和淋巴细胞的数量来量化炎症反应。新生血管形成和包膜形成也分别通过新毛细血管的数量和包膜的存在及厚度来量化。
共收集了 109 例患者（170 侧乳房）的组织学标本。在没有辅助治疗的情况下，AlloDerm 和 DermaMatrix 在炎症、新生血管形成或包膜厚度方面没有显著差异。两种脱细胞真皮基质在辅助治疗后炎症和新生血管形成均显著减少。当使用化疗和放疗时，DermaMatrix 重建组的炎症减少最为明显（p < 0.039）。
辅助治疗影响两种脱细胞真皮基质的炎症反应、新生血管形成和包膜形成。辅助治疗对乳房再造中两种脱细胞真皮基质的炎症反应均有保护作用。在化疗和放疗的情况下，DermaMatrix 引起的炎症减少最为明显。
临床问题/证据水平：治疗性，II 级。
