The Biomechanical Properties of Meshed versus Perforated Acellular Dermal Matrices (ADMs)

Abstract

Background: Acellular dermal matrices (ADMs) are used for soft tissue augmentation across surgical specialties. Since allograft incorporation depends on direct opposition between the ADM and a vascular bed, seroma formation can be detrimental to incorporation. Since most ADM products are available in many meshed and perforated forms, there is a lack of consistency between manufacture designs. We set out to determine the fluid egress properties and increase in surface area resulting from common cut patterns. Methods: Three ADM cut patterns were studied: 1 meshed and 2 perforated. We calculated the surface area of these modified ADM samples. Fluid was passed through each ADM, and time required for fluid passage was recorded. An ANOVA ( P < 0.05) was used to determine if there was a significant difference in egress properties across the 3 patterns. Results: Meshing in a 1:1 pattern resulted in a 97.50% increase in surface area compared with the uncut product. In comparison, only a 0.30% increase resulted from Perforation Pattern #1 and a 0.59% increase resulted from Perforation Pattern #2. There was a significant difference in egress properties across the three cut patterns ( P = 0.000). The average egress time of Mesh Pattern #1 was 1.974 seconds. The average egress time of Perforation Pattern #2 was 6.504 seconds, and of Perforation Pattern #1 was 10.369 seconds. Conclusions: Quantitative comparison revealed that meshing ADM significantly improves fluid egress and increases the surface area. Therefore, the use of meshed ADM tissue could improve the incorporation of ADM with the recipient, with improved patient outcomes.

Der Stellenwert von synthetischen Netzen und biologischen Matrices in der Implantat-basierten Brustrekonstruktion

“…Dies ist vermutlich der langsameren Neovaskularisierung und dementsprechenden späteren Integration der ADM geschuldet [49]. Neben dem Einsatz unterschiedlich dicker Matrices ist auch die Verwendung netzartiger, gemeshter Matrices eine Möglichkeit, das implantierte Material zu verringern und die Inkorporation der ADM zu verbessern [50,51]. Gerade bei schlanken Patientinnen oder dünnen Mastektomie-Lappen bleibt letztendlich fraglich, ob die präpektorale Lage durch die vollständige Umwicklung des Implantats mit verhältnismäßig viel ADM-Material erzwungen werden sollte, oder ob das ungünstige Verhältnis zwischen Patientengewebe und zu integrierender Matrix ein unverhältnismäßig hohes Komplikationsrisiko birgt.…”