Sterile acellular matrices 'reliable in expander-based breast reconstruction'

Sterile human acellular dermal matrix offers reliable matrix incorporation and a low complication rate for expander-based breast reconstruction, the results of a US study indicate, which also suggest that sterilization does not affect incorporation success.

The team says: "The use of ADMs with immediate expander-based breast reconstruction is increasing in popularity… The preliminary data suggest that a sterile human acellular dermal matrix offers an advantage over aseptic human acellular dermal matrix with regard to the rate of infection and seroma."

Mark Venturi and team, from Georgetown University Medical Center, in Washington, DC, USA, used sterile human acellular dermal matrix in 65 consecutive tissue expander-based reconstructions performed in 39 patients over 1 year by 14 surgeons. They report that all patients had complete incorporation of the acellular dermal matrix by the time of second-stage reconstruction.

Furthermore, biopsies taken from the first 20 breasts completed revealed histologic evidence of incorporation, with neovascularization and collagen deposits observed, the researchers note in Plastic and Reconstructive Surgery.

Three breasts in two patients were found to have early postoperative complications. One patient with bilateral reconstruction experienced bilateral mastectomy flap necrosis that required excision and removal of fluid from the tissue expander.

The other patient, who also underwent bilateral reconstruction, had a unilateral cellulitis that resolved with intravenous antibiotics. In neither case was the incorporation or reconstruction affected. This patient was diabetic but was not excluded because they were not insulin dependent and therefore not significantly immunocompromised.

Over an average follow up of 12 months, at a range of 9 to 18 months, there were no cases of seroma or explanation.

The team writes: "A randomized prospective direct head-to-head comparison is the next logical step to better define the risk profile of sterile versus aseptic acellular dermal matrices."

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