Comparison of Outcomes Using AlloDerm Versus FlexHD for Implant-Based Breast Reconstruction

Liu, Daniel Z.; Mathes, David W.; Neligan, Peter C.; Said, Hakim K.; Louie, Otway

doi:10.1097/sap.0b013e318268a87c

Cited by 50 publications

(27 citation statements)

References 18 publications

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“…A number of manufacturers supply a large variety of ADM options, which vary in sterile preparation, need for rehydration and shelf-lives. Several reports have attempted to assess differences in clinical complication rates among these products but have returned mixed results (23, 24). …”

Section: Discussionmentioning

confidence: 99%

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Sorkin

Kim

et al. 2017

Plastic &Amp; Reconstructive Surgery

125

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INTRODUCTION Acellular dermal matrix (ADM) has gained widespread acceptance in immediate expander/implant reconstruction due to perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of ADM on other outcomes, including patient-reported measures. METHODS The Mastectomy Reconstruction Outcomes Consortium (MROC) Study used a prospective cohort design to evaluate patients undergoing post-mastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women receiving immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and PRO data, using the BREAST-Q and Numeric Pain Rating Scale (NPRS) instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied. RESULTS A total of 1,297 patients were evaluated, including 655 (50.5%) with ADM and 642 (49.5%) without ADM. Controlling for demographic and clinical covariates, no significant differences were seen between ADM and non-ADM cohorts in overall complications (OR=1.21, p=0.263), major complications (OR=1.43, p=0.052), wound infections (OR=1.49, p=0.118), or reconstructive failures (OR=1.55, p=0.089) at two years following reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p=0.78). No significant differences were observed in PRO scores, including satisfaction with breast, psychosocial well-being, sexual well-being, physical well-being and postoperative pain. CONCLUSION In our multicenter, prospective analysis, we found no significant ADM effects on complications, time to exchange or PRO in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of ADM in these patients.

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Section: Discussionmentioning

confidence: 99%

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Sorkin

Kim

et al. 2017

Plastic &Amp; Reconstructive Surgery

125

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“…Infection rates in cases using acellular matrices trended higher than in those that did not; however, none of the studies found these differences statistically significant. [17][18][19][20][21][22][23][24] Maintenance of AlloDerm viability and formation of granulation tissue was seen even if the site was infected after incorporation of the AlloDerm into the host tissue. This suggests that the revascularization process is adequate to eliminate the bacterial load.…”

Section: Discussionmentioning

confidence: 99%

Revascularization of AlloDerm Used during Endoscopic Skull Base Surgery

et al. 2018

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Objectives AlloDerm is an acellular dermal matrix often used for reconstruction throughout the body. AlloDerm has been shown to undergo revascularization when used to reconstruct soft tissue such as in abdominal wall reconstruction. In this study, the authors review the literature on revascularization of AlloDerm and demonstrate the histologic findings of AlloDerm after implantation during skull base reconstruction. Study Design Literature review and case reports. Setting Tertiary Care Institution Participants Patients from a tertiary care institution Main Outcome Measures Histologic slides are evaluated and compared with nonimplanted AlloDerm. Methods The authors review a case of explanted AlloDerm that had been used for skull base reconstruction after endoscopic skull base surgery. Results Upon reviewing the histologic slides of explanted AlloDerm to nonimplanted AlloDerm, we demonstrate revascularization of AlloDerm when used in skull base reconstruction. Representative slides will be included. Conclusions AlloDerm undergoes revascularization when used for skull base reconstruction.

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“…Alloderm has been on the market for a long time, and as such, this is the product that other products are most frequently compared against. Retrospective studies comparing Alloderm to Surgimend â , 4 Stratticeä, 7 FlexHD â , 17 and DermaMatrixä 9 have failed to show a significant difference between the clinical outcomes of these ADM products. However, it is important to note that the Alloderm product studied in these reviews is the earlier RTM product.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two cadaveric acellular dermal matrices for immediate breast reconstruction: A prospective randomized trial

Hinchcliff

Orbay

Busse

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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AlloDerm RTU and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant-based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients undergoing implant-based breast reconstruction were randomized into AlloMax or AlloDerm arms (n = 15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on postoperative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration. Patient satisfaction was evaluated using the BRECON-31 questionnaire 1 year after implant exchange. A cost analysis was performed comparing the two ADMs. Patient demographics and complication rates were similar between the two groups (p > 0.05). Histologically, vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side (p < 0.01) in both ADMs, suggesting greater vascular and cellular in-growth from the dermal side. Vessel density in the middle portion of the Allomax biopsies was significantly higher than the same site in the Alloderm biopsies (p < 0.05). The extent of fibroblast/inflammatory cell infiltration was similar in both arms (p > 0.05). The BRECON-31 satisfaction questionnaire yielded similar responses across all metrics between the two study arms. The negotiated price was slightly different when comparing the two ADMs, with no significant difference in ADM reimbursement. In this study, AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes.

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Comparison of Outcomes Using AlloDerm Versus FlexHD for Implant-Based Breast Reconstruction

Abstract: There is no significant difference in the complication rates between AlloDerm and FlexHD in immediate breast reconstruction. Multivariate analysis suggests that FlexHD may be a risk factor for implant loss.

Cited by 50 publications

References 18 publications

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits

Revascularization of AlloDerm Used during Endoscopic Skull Base Surgery

Comparison of two cadaveric acellular dermal matrices for immediate breast reconstruction: A prospective randomized trial

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