Complications of Acellular Dermal Matrices in breast surgery

Despite the fact that acellular dermal matrices are treated under aseptic conditions to minimize immunogenicity while simultaneously maintaining matrix structure to permit host cells to repopulate the graft.22,24 the theoretical risk of infection has been investigated thoroughly. Ultimately, human acellular dermal matrix should be able to resist infection owing to its ability to revascularize, recullularize and integrate itself within the host tissue following implantation.25 However due to the time required for such processes to happen, a window period emerges whereby infection can occur.

Another concern with the use of acellular dermal matix is its ability to tolerate exposure to irradiation.25,26 In a study by Nahabedian 25 to determine the aptitude of AlloDerm® to resist infection and irradiation, 476 breasts (361 women) that underwent reconstruction; 100 breasts (76 women) using Alloderm® and the rest without were compared. It was found that the rate of infection did not differ significantly between the AlloDerm® group (5%) and the control group (5.85%). In addition, irradiation had no effect on the rate of infection or adherence. Reported complications included seroma (5%), dehiscence (4%) and skin necrosis (3%) which can occur with standard reconstruction when exposed to radiotherapy. Overall, it was demonstrated that the risk of infection did not vary with or without AlloDerm® and that it is perfectly tolerant of both infection and irradiation.

Komorowska-Timek et al20 suggest that the use of AlloDerm® reduces the rate of radiation related inflammation and pseudoepithelium formation in a study were 2 implants were placed in the backs of 41 rats, 20 of which underwent irradiation of their implants and 21 who served as controls. It was observed that radiation induced inflammation increased at 12 weeks in the control group but was diminished in the AlloDerm® group. This data supports the use of AlloDerm® limiting the progression of contraction, fibrosis and capsular formation.

Bindingnavele et al12 analyzed the charts of 41 patients (65 breast) who underwent staged breast reconstruction with acellular cadaveric dermis for complication rates and found that they were extremely low; seroma (3 patients), wound infection (2 patients), hematoma (1 patient) and expander removal (1 patient).

Nguyen et al27 found that there were no variations in the readmission rates for IV antibiotics in a series of 321 implant based reconstructions of whom 75 used Alloderm® and 246 did not. However, the rate of explanation as a result of infected fluid collections was significantly lower in the control group in comparison to the AlloDerm® group.

In contrast, Chun et al19 reported an increase in the rate of infections and seroma in a series of 415 implant-based reconstructions where the use of acellular dermal matrices contributed to a rise in the incidence of seroma by 4.24 times and of infection by 5.37 times. They emphasize careful and meticulous post operative management. In another study by Lanier et al28 the increase in rate of infection with use of acellular dermal matrices was attributed to size of the breast being larger than 600g.

Liu et al22 used acellular dermal matrix and observed an elevation in the risk of infection that was not of statistical significance. This higher complication rate could perhaps be due to other individual risk factors; higher body mass index, smoking, larger implant size, which are known to cause an increase in the overall complication rate.

In a metanalysis of 53 articles, Adetayo et al1 identified the most common complication associated with the use of Acelluar Dermal Matrices in Breast and Abdominal wall surgery as being wound infection; 16% followed by seroma formation and breast implant failure; 8% and 6% respectively. It was also mentioned that administration of chemotherapy increased the rate of seroma and exposure to radiation raised the incidence of cellulitis.
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Continue on to other Dermal Matrices in Breast Augmentation Articles

Part I: Types of Dermal Matrices in Breast Augmentation
Part II: Dermal Matrices in Breast Augmentation
Part III: Complications of Dermal Matrices in Breast Augmentation
Part IV: Dermal Matrices in Breast Reconstruction
Part V: Dermal Matrices in Breast Augmentation Summary

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Chapter 1: Preoperative Workup in the Plastic Surgery Patient
Chapter 2: Photography in Plastic Surgery
Chapter 3: Facelift
Chapter 4: Fat Grafting
Chapter 5: Fillers
Chapter 6: The Role of Dermal Matrices in Breast Augmentation
Chapter 7: Scar Revision in Plastic Surgery

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References

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3.         LifeCell Corporation. AlloDerm Tissue Matrix defined 2011. Available at http://www.lifecell.com/alloderm-regenerative-tissue-matrix/95/. Accessed July 24, 2011.

4.         LifeCell Corporation. Tissue regeneration 2011 Available at http://www.lifecell.com/alloderm-regenerative-tissue-matrix/96/.  Accessed July 24, 2011.

5.         LifeCell Corporation. AlloDerm Regenerative Tissue Matrix Benefits 2011. Available at http://www.lifecell.com/alloderm-regenerative-tissue-matrix/53/. Accessed July 24, 2011.

6.         LifeCell Corporation. Breast Reconstruction 2011. Available at http://www.lifecell.com/strattice-reconstructive-tissue-matrix/255/. Accessed July 24, 2011.

7.         Synthes CMF, Musculoskeletal Transplant Foundation. DermaMatrix Acellular Dermis Human dermal collagen matrix 2006. Available at http://www.synthes.com/MediaBin/US%20DATA/Product%20Support%20Materials/Brochures/CMF/MXBRODermaMatrixAcellular-J7237D.pdf. Accessed July 24, 2011.

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18.       Losken A. Early Results Using Sterilized Acellular Human Dermis (Neoform) in Post-Mastectomy Tissue Expander Breast Reconstruction. Plast Reconstr Surg. Mar 23 2009.

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21.       Mofid MM, Singh NK. Pocket conversion made easy: a simple technique using alloderm to convert subglandular breast implants to the dual-plane position. Aesthet Surg J. Jan-Feb 2009;29(1):12-18.

22.       Liu AS, Kao HK, Reish RG, Hergrueter CA, May JW, Jr., Guo L. Postoperative complications in prosthesis-based breast reconstruction using acellular dermal matrix. Plast Reconstr Surg. May 2011;127(5):1755-1762.

23.       Hartzell TL, Taghinia AH, Chang J, Lin SJ, Slavin SA. The use of human acellular dermal matrix for the correction of secondary deformities after breast augmentation: results and costs. Plast Reconstr Surg. Nov 2010;126(5):1711-1720.

24.       Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. Feb 2011;127(2):514-524.

25.       Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg. Dec 2009;124(6):1743-1753.

26.       Isken T, Onyedi M, Izmirli H, Alagoz S, Katz R. Abdominal fascial flaps for providing total implant coverage in one-stage breast reconstruction: an autologous solution. Aesthetic Plast Surg. Nov 2009;33(6):853-858.

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