by Kyle Sanniec, MD, MHA (@drkylesanniec)
Plastic Surgery Resident
University of Texas Southwestern
The March edition of #PRSJournalClub provided a wonderful opportunity to discuss the PRS article “Evaluation of Acellular Dermal Matrix Efficacy in Prosthesis-Based Breast Reconstruction” by Sobti, Ji, Brown, Cerudo Jr, Colwell, Winograd, Austen Jr, and Liao. The article can be read here.
The goal of this study was to evaluate the clinical evidence of acellular dermal matrix (ADM) efficacy in prosthetic breast reconstruction. With the use of tissue expander fill as the primary efficacy endpoint, a comparison between patients who underwent ADM vs non-ADM reconstruction was performed. The authors hypothesize that using ADM will lead to increased initial fill volume intra-operatively and shorter duration before final implant exchange can be performed.
A retrospective chart review from April 2004 to June 2016 was performed. The authors divided patients into two groups: an ADM group and non-ADM group (patients who underwent total muscle coverage or partial muscle coverage with no reinforcing material). Patient demographics, expander fill data, and complications were evaluated.
A total of 1180 consecutive mastectomies followed by tissue expander placement were identified. Approximately half, 591 breasts underwent ADM based tissue expander placement and 589 underwent non-ADM tissue expander reconstruction. The mean follow-up was over 5 years. The only differences in demographics between the groups was that the non-ADM group was more likely to have a smoking history and the ADM group was more likely to undergo radiation.
The three most common complications were surgical site infection (4.7%), tissue necrosis (3.7%) and hematoma (0.6%). A history of smoking (OR, 4.93, 95%CI, 2.39-10.16) and BMI (OR, 1.10; 95% CI, 1.05 to 1.15) were independent predictors of tissue necrosis. There was a statistically higher rate of tissue necrosis in the non-ADM group than the ADM group (5.1% vs 2.4%, p=0.01). There were no other significant differences in outcomes.
The initial tissue expander fill volume was higher in the ADM group (180.8 versus 45.8, p=0.00), but final implant size achieved was comparable. The ratio of initial tissue expander fill volume compared with final implant volume strongly favored the ADM group. Additionally, there were fewer fill visits than in the non-ADM group (5.0 versus 6.7), and a shorter time from expander to implant exchange (5.4 vs. 7.0).
The authors conclude that ADM expander reconstruction was associated with higher fill volume, fewer fill visits, and shorter interval to implant exchange than non-ADM reconstruction. They conclude that the use of ADM has an increased efficacy than non-ADM and that the use of ADM was associated with an increase in direct-to-implant reconstruction.
This article was first discussed by the current Resident Ambassadors to the PRS Editorial Board Francesco Egro (@FrancescoEgro), Nicole Phillips (@DrNikkiPhillips), and Ira Savetsky (@IraSavetskyMD), and the special guest moderator Dr. Bruce Mast. Listen to the podcast discussion below:
This was followed by a robust discussion during the #PRSJournalClub Facebook Q and A. Some of the excerpts are found below as the authors provided an interactive discussion of their research.
Enjoy reviewing the article and the interactive discussion, and as always follow the journal on Facebook and Twitter (@PRSJournal), the PRS Resident Ambassadors: Francesco Egro (@FrancescoEgro), Nicole Phillips (@DrNikkiPhillips), and Ira Savetsky (@IraSavetskyMD), or myself (@DrKyleSanniec) for information on the next #PRSJournalClub.