Comparison of Acellular Dermal Matrix and Synthetic Mesh for Lateral Chest Wall Reconstruction in a Rabbit Model

Holton, Luther H.; Chung, Thomas L.; Silverman, Ronald P.; Haerian, Hafez; Goldberg, Nelson H.; Burrows, W.; Gobin, Andrea S.; Butler, Charles E.

doi:10.1097/01.prs.0000254347.36092.9c

Cited by 49 publications

(36 citation statements)

References 23 publications

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“…8). 21,22 There was no additional layer of tissue histologically resembling a capsule beneath the AlloDerm to suggest that a capsule had formed at the layer in close proximity with the implant. Similarly, no capsule layer was visualized superficial to the AlloDerm to suggest a foreign body reaction to the acellular dermal matrix itself.…”

Section: Discussionmentioning

confidence: 94%

The Use of Acellular Dermal Matrix to Prevent Capsule Formation around Implants in a Primate Model

Stump

Holton

Connor

et al. 2009

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 94%

The Use of Acellular Dermal Matrix to Prevent Capsule Formation around Implants in a Primate Model

Stump

Holton

Connor

et al. 2009

Plastic and Reconstructive Surgery

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“…Consisting of acellular organic collagenbased matrices it allows for native tissue re-growth and revascularization, stimulating regeneration as opposed to scarring with minimal inflammatory response and less inclination to rejection. Differently to synthetic meshes, it can be placed directly over the lung and viscera without any complications, but not resulting in a rigid reconstruction of the thoracic wall, even if the stability achieved is enough to prevent paradoxical motions or respiratory distress (18,19). The only limitation is the elevated costs (16).…”

Section: Synthetic Biologic and Titanium Meshesmentioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage. by scapula and shoulder girdle, with the exception of defects lower than 4th rib posteriorly, with the tip of the scapula at risk to entrapment (3,12,13). With the increased availability of reconstruction materials, then, and particularly biologic materials, some surgeons proposed the reconstruction of nearly all chest wall defects, with the objective to avoid patient perception of chest wall instability (3,5,13).The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs, provide soft tissue coverage, minimize deformity and allow patients to receive adjuvant radiotherapy if indicated (3,9). Therefore, a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons as well as medical and radiation oncologists is essential.Actually several synthetic, biologic, and metallic materials are available to reconstruct the chest wall defects, but each prosthetic material has its own advantages and disadvantages and none have proven to be clearly superior (4,12). In particular, the benefit of each material and technique of reconstruction need to be weighed against to main indicators, as the risk of infection and other major complications that could be fail the reconstructive result.The recent advance in allograft and homograft production have provided new alternatives for restoring structural stability, preventing the infective complications (3,14).We would describe the main reconstructive techniques and materials more adopted on Literature reports and an overview to the incoming future of chest wall reconstruction. Synthetic, biologic and titanium meshesThe use of a metal prostheses was first reported by a French surgeon in 1909 (15), but in the 1940s better-tolerated and easier to use materials, as plastic components emerged, modifying the ...

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“…Our understanding of ADM remodeling in prosthetic breast reconstruction is derived from clinical experience 54, 55 , translational animal models 53, 56–58 , and extrapolation from the hernia literature 48, 59 . Remodeling of an ADM sandwiched between well-vascularized surfaces 60–62 is expected to be more robust than around a prosthesis.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Chemotherapy and Radiation Therapy on the Remodeling of Acellular Dermal Matrices in Staged, Prosthetic Breast Reconstruction

Myckatyn

Cavallo

Sharma

et al. 2015

Plastic and Reconstructive Surgery

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Background An acellular dermal matrix (ADM) used in prosthetic breast reconstruction will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients that require chemotherapy and radiation therapies that influence neovascularization and cellular proliferation. Methods Multiple biopsies of the submuscular capsule and ADM were procured from 86 women (N=94 breasts) undergoing exchange of a tissue expander for a breast implant. These were divided by biopsy location : submuscular capsule (control) as well as superiorly, centrally and inferiorly along the ADM. Specimens were assessed grossly for incorporation and semi-quantitatively for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, as well as Type I and III collagen area and ratio. Five oncologic treatment groups were compared : no adjuvant therapy (untreated), neoadjuvant chemotherapy ± radiation ; and chemotherapy ± radiation. Results ADM and submuscular capsule biopsies were procured 45 to 1805 days after ADM insertion and demonstrated a significant reduction in Type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation relative to the untreated group (p=0.03). Chemotherapy with or without radiation adversely impacted Type I collagen area (p=0.02), cellular infiltration (p<0.01), extracellular matrix deposition (p<0.04), and neovascularization (p<0.01). Radiation exacerbated the adverse impact of chemotherapy for gross incorporation as well as several remodeling parameters. Neoadjuvant chemotherapy also caused a reduction in Type I (p=0.01) and III collagen (p=0.05), extracellular matrix deposition (p=0.03), and scaffold degradation (p=0.02). Conclusions Chemotherapy and radiation therapy limit ADM remodeling.

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Comparison of Acellular Dermal Matrix and Synthetic Mesh for Lateral Chest Wall Reconstruction in a Rabbit Model

Cited by 49 publications

References 23 publications

The Use of Acellular Dermal Matrix to Prevent Capsule Formation around Implants in a Primate Model

The Use of Acellular Dermal Matrix to Prevent Capsule Formation around Implants in a Primate Model

Materials and techniques in chest wall reconstruction: a review

The Impact of Chemotherapy and Radiation Therapy on the Remodeling of Acellular Dermal Matrices in Staged, Prosthetic Breast Reconstruction

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