What’s New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction

Kim, John Y.S.; Mlodinow, Alexei S.

doi:10.1097/prs.0000000000003950

Cited by 30 publications

(23 citation statements)

References 96 publications

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“… 22 Synthetic mesh products have been by definition a more heterogenous group due to their different constituent polymers, yet they have overall seen increased adoption in the face of high ADM costs. 23-25 The value proposition of the Durasorb PDO mesh is in the long-term stability of the breast implant pocket with a minimal complication profile and is demonstrated by the current pilot series. At the average follow-up of approximately 1 year, and up to 2 years in some of the earlier patients, no changes in implant position were noted by the authors or patients.…”

Section: Discussionmentioning

confidence: 75%

Bioabsorbable Polydioxanone Mesh for Soft Tissue Reinforcement in Revisional Breast Surgery

Turin¹,

Gutowski²

2022

Aesthetic Surgery Journal Open Forum

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Background Need for revision procedures after breast implant surgery often arises from the failure of soft tissues to provide a stable implant pocket. Meshes or dermal matrices have been used to reinforce the implant’s soft tissue support. Durasorb (Surgical Innovation Associates, Chicago, IL) is a resorbable polydioxanone (PDO) mesh indicated for soft tissue reinforcement. Its monofilament, macroporous design allows for ease of handling and rapid tissue incorporation. The extended timeline of PDO bioabsorption provides support during the critical portions of soft tissue healing while avoiding long-term complications of permanent products. Objectives Evaluate the efficacy of Durasorb PDO mesh for soft tissue reinforcement in revision breast surgery. Methods This is a prospective case series of 17 patients (27 breasts) undergoing revision breast implant surgery with Durasorb PDO mesh Results Five patients (5 breasts) presented for revision after implant placement for breast reconstruction, with the remaining 22 presenting for revision after implant placement for cosmetic indications. Average patient age was 47.9 years, and average BMI 24.3. Indications for surgery were implant malposition (37%), capsular contracture (30%), poor cosmesis/asymmetry (26%), and recurrent soft tissue ptosis (7%). Follow up averaged 355 days (range 174 to 799 days, SD=155). One patient experienced a seroma 2 weeks post-operatively, which resolved after a single aspiration. No infections, wound healing problems, or recurrences of implant malposition/capsular contracture were encountered. Conclusions Durasorb PDO mesh appears to be efficacious as a breast implant pocket reinforcement in the reoperative setting with a low complication rate and durable results.

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Section: Discussionmentioning

confidence: 75%

Bioabsorbable Polydioxanone Mesh for Soft Tissue Reinforcement in Revisional Breast Surgery

Turin¹,

Gutowski²

2022

Aesthetic Surgery Journal Open Forum

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“… 67 ADM integration with fenestrations and perforations led to decreased risk of infection, duration of tissue draining and length of hospital stay. 68 …”

Section: Resultsmentioning

confidence: 99%

Clinical applications of acellular dermal matrices: A review

Petrie

Cox

Becker

2022

Scars, Burns & Healing

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Introduction The extracellular matrix (ECM) plays an integral role in wound healing. It provides both structure and growth factors that allow for the organised cell proliferation. Large or complex tissue defects may compromise host ECM, creating an environment that is unfavourable for the recovery of anatomical function and appearance. Acellular dermal matrices (ADMs) have been developed from a variety of sources, including human (HADM), porcine (PADM) and bovine (BADM), with multiple different processing protocols. The objective of this report is to provide an overview of current literature assessing the clinical utility of ADMs across a broad spectrum of applications. Methods PubMed, MEDLINE, EMBASE, Scopus, Cochrane and Web of Science were searched using keywords ‘acellular dermal matrix’, ‘acellular dermal matrices’ and brand names for commercially available ADMs. Our search was limited to English language articles published from 1999 to 2020 and focused on clinical data. Results A total of 2443 records underwent screening. After removing non-clinical studies and correspondence, 222 were assessed for eligibility. Of these, 170 were included in our synthesis of the literature. While the earliest ADMs were used in severe burn injuries, usage has expanded to a number of surgical subspecialties and procedures, including orthopaedic surgery (e.g. tendon and ligament reconstructions), otolaryngology, oral surgery (e.g. treating gingival recession), abdominal wall surgery (e.g. hernia repair), plastic surgery (e.g. breast reconstruction and penile augmentation), and chronic wounds (e.g. diabetic ulcers). Conclusion Our understanding of ADM’s clinical utility continues to evolve. More research is needed to determine which ADM has the best outcomes for each clinical scenario. Lay Summary Large or complex wounds present unique reconstructive and healing challenges. In normal healing, the extracellular matrix (ECM) provides both structural and growth factors that allow tissue to regenerate in an organised fashion to close the wound. In difficult or large soft-tissue defects, however, the ECM is often compromised. Acellular dermal matrix (ADM) products have been developed to mimic the benefits of host ECM, allowing for improved outcomes in a variety of clinical scenarios. This review summarises the current clinical evidence regarding commercially available ADMs in a wide variety of clinical contexts.

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“…Unfortunately, despite their optimal mechanical behaviour, the use of non-absorbable meshes is often accompanied by an excessive immune reaction that results in a non-constructive remodelling of the tissue [19], adhesion to the viscera, erosion, [5] infectious complications [100] and, in the case of periodontal GBR membranes, a second surgery for removal [42].…”

Section: Non-absorbable Synthetic Materialsmentioning

confidence: 99%

“…Allograft and xenografts are obtained by dermis decellularization in order to remove cells from the tissue, leaving just the organized collagen architecture (ECM) and producing a structure that can be generally called ADM [10]. These types of matrices have been very often used in hernia [18], PFDs [108], BR [100] and wound-healing applications [93] aiming to reach an integration level of the prosthesis with the native tissue with minimal or nonnegative response. Some of the most common source of ADM are rectus fascia, fascia lata [109], human dermis, porcine dermis and porcine small intestine submucosa (SIS) [3].…”

Section: Graftsmentioning

confidence: 99%

Next-generation surgical meshes for drug delivery and tissue engineering applications: materials, design and emerging manufacturing technologies

2021

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Surgical meshes have been employed in the management of a variety of pathological conditions including hernia, pelvic floor dysfunctions, periodontal guided bone regeneration, wound healing and more recently for breast plastic surgery after mastectomy. These common pathologies affect a wide portion of the worldwide population; therefore, an effective and enhanced treatment is crucial to ameliorate patients’ living conditions both from medical and aesthetic points of view. At present, non-absorbable synthetic polymers are the most widely used class of biomaterials for the manufacturing of mesh implants for hernia, pelvic floor dysfunctions and guided bone regeneration, with polypropylene and poly tetrafluoroethylene being the most common. Biological prostheses, such as surgical grafts, have been employed mainly for breast plastic surgery and wound healing applications. Despite the advantages of mesh implants to the treatment of these conditions, there are still many drawbacks, mainly related to the arising of a huge number of post-operative complications, among which infections are the most common. Developing a mesh that could appropriately integrate with the native tissue, promote its healing and constructive remodelling, is the key aim of ongoing research in the area of surgical mesh implants. To this end, the adoption of new biomaterials including absorbable and natural polymers, the use of drugs and advanced manufacturing technologies, such as 3D printing and electrospinning, are under investigation to address the previously mentioned challenges and improve the outcomes of future clinical practice. The aim of this work is to review the key advantages and disadvantages related to the use of surgical meshes, the main issues characterizing each clinical procedure and the future directions in terms of both novel manufacturing technologies and latest regulatory considerations. Graphic abstract

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What’s New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction

Cited by 30 publications

References 96 publications

Bioabsorbable Polydioxanone Mesh for Soft Tissue Reinforcement in Revisional Breast Surgery

Bioabsorbable Polydioxanone Mesh for Soft Tissue Reinforcement in Revisional Breast Surgery

Clinical applications of acellular dermal matrices: A review

Next-generation surgical meshes for drug delivery and tissue engineering applications: materials, design and emerging manufacturing technologies

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