The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;...The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> and Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, in immediate implant-based subpectoral breast reconstruction cases. <strong>Background:</strong> The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. <strong>Methods:</strong> 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (SADM), 22 cases Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (EADM) and the remaining 35 cases Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). <strong>Results:</strong> The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed a significantly lower time of hospitalization (p < 0.001). <strong>Conclusion:</strong> No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.展开更多
AIM: To present our trial using a combination of the human acellular dermal matrix (HADM) implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS...AIM: To present our trial using a combination of the human acellular dermal matrix (HADM) implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS: Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS: The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION: The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.展开更多
In the past 10 years, acellular dermal matrix (ADM) has .been widely used in various fields of surgery, includingcleft palate repair, abdominal wall repair, tendon repair, hernia repair, facial and eyelid soft tissu...In the past 10 years, acellular dermal matrix (ADM) has .been widely used in various fields of surgery, includingcleft palate repair, abdominal wall repair, tendon repair, hernia repair, facial and eyelid soft tissue augmentation surgery, ulcer repair, and vaginal sling repair, among others.1-3 ADM not only provides initial structural strength and bulk, but also allows relatively rapid vascular growth and serves as a scaffold for "new" tissue formation.4 These properties have led to its application to resolving surgical problems where tissue deficiency remains an issue. Many surgeons have begun to use ADM-assisted breast reconstruction techniques. Compared with ADM, the traditional method of implant-based breast reconstruction is more straightforward but is more prone to postoperative complications. Generally speaking, breast revision surgery procedures are complex, challenging, and unpredictable as the potential for the development of serious complications, such as capsular contracture (CC), must be addressed. CC has plagued plastic surgeons as the most common complication of reconstructive breast surgery for many yearsY The application of ADM addresses these problems, and as a result, its popularity is growing: in the United States 73% of surgeons have some experience in the use of xenogeneic or allogeneic ADM in breast reconstruction.8 Furthermore, the use of ADM in nipple and areola reconstruction can achieve a more natural appearance and avoids complications of other more traditional techniques.~ In cases of breast reconstruction, techniques that incorporate the use of ADM have been used to treat and reduce the incidence of CC, determine the position of the inframammary fold and final breast contour, enhance the use of available mastectomy skin, and increase the thickness of the soft tissue to reduce implant visibility or palpability. These goals can be achieved by replacing or extending the tissue with ADM or using ADM as a supplement. In addition to the advantages afforded by the use of ADM, the safety and efficacy of these techniques have been widely reported.1-1 Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. This article summarizes the main methods and different aspects of ADM-assisted breast reconstruction.展开更多
Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons.However,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economi...Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons.However,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economic burden on the health care system makes it a subject of frequent re-evaluations in cost-effectiveness.Prompted by the high price of$3,700 USD for a 6 cm×16 cm area,our group proposes the meshing of AlloDerm to decrease the total amount needed for breast reconstruction,while achieving comparable surgical outcomes as using unmeshed alloderm.展开更多
Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban ...Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban areas.Decades of clinical research have made considerable progress,which is attributable to improved mastectomy and maintenance of a well-perfused skin flap after mastectomy.An in-depth insight into the nature of breast cancer will contribute to reduced overall mortality and prolonged survival.In China,there is an increasing awareness of the importance of breast reconstruction in improving quality of life(QoL)and life expectancy.There has been progress in breast reconstruction surgical procedures due to demand from women.Clinicians should be aware that breast reconstruction is not only a medical problem but also a surgical problem.In the following sections,we present the epitome of advances in implant-based breast reconstruction.展开更多
Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for ...Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for the temporary,definitive,or staged repair of these defects.A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices(ADMs).In recent years,not only the type of tissue from which ADMs are produced,product range,diversity and areas of use have increased,but their use in reconstructive fields,especially in post oncologic breast surgery,has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future.It is essential that reconstructive surgeons become familiar with some of the ADM’s as well as the advantages and limitations to their use.This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the arma-mentarium of reconstructive surgeons.Brief considerations of possible future directions for ADMs are also conducted in the end.展开更多
Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, t...Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.展开更多
Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear...Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear cartilage,and acellular dermal matrix(ADM)as tarsal plate substitutes were investigated.Two cases were reviewed.Case 1 was a 22-year-old female who had total loss of the right lower eyelid.Ear cartilage(23 mm25 mm)was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilageexpander capsule compound structure for lower eyelid reconstruction.Case 2 was a 7-year-old boy with a unilateral divided nevus.The lid and conjunctiva of the lower eyelid were invaded.A piece of ADM(12 mm4 mm)was used to repair the tarsal plate defect(12 mm3 mm).The conjunctiva of ADM was covered by itself.An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction.In case 1,the compound tissue survived and supported the lower eyelid,the lid margin was clear,and the structure was complete over a 1-year follow-up.The aesthetic appearance of the eyelid improved after depilation.It is the first clinical research on the expander capsule as eyelid conjunctiva.In case 2,the conjunctiva completely covered the superior ADM,and the transplant merged with the surrounding tissues without complications after 5 months.The preserved sclera has the longest application history as a tarsal plate substitute.However,it should be preserved in an eye bank and transplanted with conjunctiva repair.Ear cartilage is an autologous tissue that requires conjunctival reconstruction.Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva.It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure.Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility,supportive strength,conjunctivalization,and not requiring donor site surgery.Plastic surgeons are familiar with autologous ear cartilage and ADM,which are easy to obtain and treat.Both ear cartilage and ADM are expected to be the first-line choices in future studies.展开更多
文摘The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> and Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, in immediate implant-based subpectoral breast reconstruction cases. <strong>Background:</strong> The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. <strong>Methods:</strong> 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (SADM), 22 cases Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (EADM) and the remaining 35 cases Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). <strong>Results:</strong> The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed a significantly lower time of hospitalization (p < 0.001). <strong>Conclusion:</strong> No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.
基金The Key Project of Science and Technology Commission of Shanghai Municipality,No. 074119649
文摘AIM: To present our trial using a combination of the human acellular dermal matrix (HADM) implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS: Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS: The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION: The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.
文摘In the past 10 years, acellular dermal matrix (ADM) has .been widely used in various fields of surgery, includingcleft palate repair, abdominal wall repair, tendon repair, hernia repair, facial and eyelid soft tissue augmentation surgery, ulcer repair, and vaginal sling repair, among others.1-3 ADM not only provides initial structural strength and bulk, but also allows relatively rapid vascular growth and serves as a scaffold for "new" tissue formation.4 These properties have led to its application to resolving surgical problems where tissue deficiency remains an issue. Many surgeons have begun to use ADM-assisted breast reconstruction techniques. Compared with ADM, the traditional method of implant-based breast reconstruction is more straightforward but is more prone to postoperative complications. Generally speaking, breast revision surgery procedures are complex, challenging, and unpredictable as the potential for the development of serious complications, such as capsular contracture (CC), must be addressed. CC has plagued plastic surgeons as the most common complication of reconstructive breast surgery for many yearsY The application of ADM addresses these problems, and as a result, its popularity is growing: in the United States 73% of surgeons have some experience in the use of xenogeneic or allogeneic ADM in breast reconstruction.8 Furthermore, the use of ADM in nipple and areola reconstruction can achieve a more natural appearance and avoids complications of other more traditional techniques.~ In cases of breast reconstruction, techniques that incorporate the use of ADM have been used to treat and reduce the incidence of CC, determine the position of the inframammary fold and final breast contour, enhance the use of available mastectomy skin, and increase the thickness of the soft tissue to reduce implant visibility or palpability. These goals can be achieved by replacing or extending the tissue with ADM or using ADM as a supplement. In addition to the advantages afforded by the use of ADM, the safety and efficacy of these techniques have been widely reported.1-1 Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. This article summarizes the main methods and different aspects of ADM-assisted breast reconstruction.
文摘Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons.However,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economic burden on the health care system makes it a subject of frequent re-evaluations in cost-effectiveness.Prompted by the high price of$3,700 USD for a 6 cm×16 cm area,our group proposes the meshing of AlloDerm to decrease the total amount needed for breast reconstruction,while achieving comparable surgical outcomes as using unmeshed alloderm.
文摘Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban areas.Decades of clinical research have made considerable progress,which is attributable to improved mastectomy and maintenance of a well-perfused skin flap after mastectomy.An in-depth insight into the nature of breast cancer will contribute to reduced overall mortality and prolonged survival.In China,there is an increasing awareness of the importance of breast reconstruction in improving quality of life(QoL)and life expectancy.There has been progress in breast reconstruction surgical procedures due to demand from women.Clinicians should be aware that breast reconstruction is not only a medical problem but also a surgical problem.In the following sections,we present the epitome of advances in implant-based breast reconstruction.
文摘Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for the temporary,definitive,or staged repair of these defects.A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices(ADMs).In recent years,not only the type of tissue from which ADMs are produced,product range,diversity and areas of use have increased,but their use in reconstructive fields,especially in post oncologic breast surgery,has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future.It is essential that reconstructive surgeons become familiar with some of the ADM’s as well as the advantages and limitations to their use.This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the arma-mentarium of reconstructive surgeons.Brief considerations of possible future directions for ADMs are also conducted in the end.
文摘Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.
基金the Shanghai Committee of Science and Technology,China(grant no.19ZR1430100)。
文摘Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons.Based on our practical work and literature review,the techniques and postoperative results of the preserved sclera,ear cartilage,and acellular dermal matrix(ADM)as tarsal plate substitutes were investigated.Two cases were reviewed.Case 1 was a 22-year-old female who had total loss of the right lower eyelid.Ear cartilage(23 mm25 mm)was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilageexpander capsule compound structure for lower eyelid reconstruction.Case 2 was a 7-year-old boy with a unilateral divided nevus.The lid and conjunctiva of the lower eyelid were invaded.A piece of ADM(12 mm4 mm)was used to repair the tarsal plate defect(12 mm3 mm).The conjunctiva of ADM was covered by itself.An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction.In case 1,the compound tissue survived and supported the lower eyelid,the lid margin was clear,and the structure was complete over a 1-year follow-up.The aesthetic appearance of the eyelid improved after depilation.It is the first clinical research on the expander capsule as eyelid conjunctiva.In case 2,the conjunctiva completely covered the superior ADM,and the transplant merged with the surrounding tissues without complications after 5 months.The preserved sclera has the longest application history as a tarsal plate substitute.However,it should be preserved in an eye bank and transplanted with conjunctiva repair.Ear cartilage is an autologous tissue that requires conjunctival reconstruction.Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva.It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure.Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility,supportive strength,conjunctivalization,and not requiring donor site surgery.Plastic surgeons are familiar with autologous ear cartilage and ADM,which are easy to obtain and treat.Both ear cartilage and ADM are expected to be the first-line choices in future studies.