From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2023 Oct 1;152(4):872-881. doi: 10.1097/PRS.0000000000010292. Epub 2023 Feb 14.
Abdominal wall reconstruction (AWR) is one of the most commonly performed procedures, yet large comparative studies comparing outcomes of AWR using bovine acellular dermal matrix (BADM) and porcine acellular dermal matrix (PADM) are lacking.
In this retrospective cohort study of patients who underwent AWR from March of 2005 to June of 2019, the primary comparative outcome measure was hernia recurrence with BADM versus PADM. The secondary outcome was the incidence of surgical-site occurrence (SSO) and surgical-site infection. A propensity score matching approach was applied to compare the clinical outcomes between the two study groups.
The authors identified 725 patients who underwent AWR using BADM (50.5%) or PADM (49.5%). Their mean ± SD age was 59.8 ± 11.5 years, mean body mass index was 31.4 ± 6.7 kg/m 2 , and mean follow-up time was 42 ± 29 months. With propensity score matching, 219 matched pairs were identified. Hernia recurrence rates in BADM (11.4%) and PADM (13.7%) groups did not differ significantly ( P = 0.793). SSO (26.5% versus 29.2%; P = 0.518) and SSI (13.2% versus 11%; P = 0.456) rates did not differ significantly in the PADM and BADM groups, respectively. Conditional logistic regression model and marginal Cox proportional hazards regression model determined that type of acellular dermal matrix was not significantly associated with SSOs (adjusted OR, 1.11; 95% CI, 0.74 to 1.70; P = 0.589) or hernia recurrence (adjusted hazard ratio, 0.85; 95% CI, 0.50 to 1.42; P = 0.52).
Both BADMs and PADMs provide durable, long-term outcomes. The hernia recurrence and postoperative surgical complication rates were not significantly different between BADM and PADM.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
腹壁重建（AWR）是最常进行的手术之一，但缺乏比较使用牛去细胞真皮基质（BADM）和猪去细胞真皮基质（PADM）进行 AWR 结果的大型对照研究。
在这项回顾性队列研究中，纳入了 2005 年 3 月至 2019 年 6 月期间接受 AWR 的患者，主要的对比结果测量指标是使用 BADM 与 PADM 的疝复发率。次要结果是手术部位发生（SSO）和手术部位感染的发生率。应用倾向评分匹配方法比较两组患者的临床结果。
作者确定了 725 例使用 BADM（50.5%）或 PADM（49.5%）进行 AWR 的患者。他们的平均年龄 ± 标准差为 59.8 ± 11.5 岁，平均体重指数为 31.4 ± 6.7kg/m 2 ，平均随访时间为 42 ± 29 个月。经过倾向评分匹配，共匹配了 219 对。BADM（11.4%）和 PADM（13.7%）组的疝复发率差异无统计学意义（P = 0.793）。SSO（26.5%比 29.2%；P = 0.518）和 SSI（13.2%比 11%；P = 0.456）发生率在 PADM 和 BADM 组之间差异均无统计学意义。条件逻辑回归模型和边缘 Cox 比例风险回归模型确定，去细胞真皮基质的类型与 SSO （调整后的比值比，1.11；95%CI，0.74 至 1.70；P = 0.589）或疝复发（调整后的危险比，0.85；95%CI，0.50 至 1.42；P = 0.52）无显著相关性。
BADM 和 PADM 均提供持久的长期结果。BADM 和 PADM 的疝复发和术后手术并发症发生率无显著差异。
临床问题/证据水平：治疗性，III 级。
