Relevant bibliographies by topics / Acellular dermal matrices

Academic literature on the topic 'Acellular dermal matrices'

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Published: 14 March 2023

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Journal articles on the topic "Acellular dermal matrices"

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Chun, Joseph T., and Brian M. Freeman. "Acellular Dermal Matrices." Plastic and Reconstructive Surgery 128 (October 2011): 96–97. http://dx.doi.org/10.1097/01.prs.0000406323.55930.bc.

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Hui, A., P. Hong, and M. Bezuhly. "Use of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction: systematic review." Journal of Laryngology & Otology 131, no. 7 (May 15, 2017): 585–92. http://dx.doi.org/10.1017/s0022215117001049.

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AbstractBackground:Acellular dermal matrices are increasingly used in laryngotracheal and pharyngeal reconstruction, but specific indications and the type of acellular dermal matrix used vary. The authors systematically reviewed outcomes relating to acellular dermal matrix use in head and neck reconstruction.Methods:Electronic databases were searched through 1 May 2016 for literature on acellular dermal matrix use in laryngotracheal and pharyngeal reconstruction. Studies were appraised for surgical indications, outcomes and study design.Results:Eleven publications with 170 cases were included. Eight articles reported on acellular dermal matrix use in oncological reconstruction. Most studies were case series; no high-level evidence studies were identified. Graft extrusion was more common in non-oncological applications. In general, post-oncological reconstruction with an acellular dermal matrix demonstrated complication rates similar to those reported without an acellular dermal matrix.Conclusion:Evidence in support of acellular dermal matrix use in head and neck reconstruction is generally poor. Prospective comparative studies are required to define the indications, safety and effectiveness of acellular dermal matrices in laryngotracheal and pharyngeal reconstruction.
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Janis, Jeffrey E., and Maurice Y. Nahabedian. "Acellular Dermal Matrices in Surgery." Plastic and Reconstructive Surgery 130 (November 2012): 7S—8S. http://dx.doi.org/10.1097/prs.0b013e31825f2d20.

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Alharbi, Mohammed Attallah, Fahad K. Aljindan, Reshan Mane Al Reshan, Khalid Dakhelallah Almutairi, Fatimah Mofeed Almosabh, Moayad Abdullah Zarbh, Renad Adel Bahadi, et al. "Acellular dermal matrices in immediate breast reconstruction: a literature review." International Journal Of Community Medicine And Public Health 8, no. 2 (January 27, 2021): 933. http://dx.doi.org/10.18203/2394-6040.ijcmph20210036.

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There has been an increase in invasive breast carcinoma which many times end up with a mastectomy. The psychological effects of mastectomy can be overwhelming, urging the need for optimum breast reconstruction procedures. Acellular dermal matrices are widely used nowadays due to their favorable outcomes with a few complications. In this study, we review the literature to explore the different types used, cons, and pros of this procedure. Databases like PubMed, Medline, Web of science, Embase, Google scholar, and Scopus were used and searched for following terms “implant-based reconstruction” or “breast reconstruction” or “acellular dermal matrix”. All studies that discuss the use of acellular dermal matrices for breast reconstructive surgery were included. Acellular dermal matrices may allow a relatively easy, affordable and time-efficient breast reconstructive surgery. They are associated with less incidence of infection and capsular contracture making them an excellent fit for most procedures. However, m ore studies are needed to help understand possible risk factors, and complications and how to avoid them.
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Ellis, Chandra V., and David A. Kulber. "Acellular Dermal Matrices in Hand Reconstruction." Plastic and Reconstructive Surgery 130 (November 2012): 256S—269S. http://dx.doi.org/10.1097/prs.0b013e318265a5cf.

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Ibrahim, Ahmed M. S., Olubimpe A. Ayeni, Kenneth B. Hughes, Bernard T. Lee, Sumner A. Slavin, and Samuel J. Lin. "Acellular Dermal Matrices in Breast Surgery." Annals of Plastic Surgery 70, no. 6 (June 2013): 732–38. http://dx.doi.org/10.1097/sap.0b013e31824b3d30.

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Kankam, HKN, GJM Hourston, P. Forouhi, M. Di Candia, GC Wishart, and CM Malata. "Combination of acellular dermal matrix with a de-epithelialised dermal flap during skin-reducing mastectomy and immediate breast reconstruction." Annals of The Royal College of Surgeons of England 100, no. 8 (November 2018): e197-e202. http://dx.doi.org/10.1308/rcsann.2018.0127.

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IntroductionPatients with large ptotic breasts undergoing immediate implant-based reconstruction often require skin-reducing mastectomy to optimise the aesthetic outcome. However, healing complications, especially at the resulting inverted T-junction, leading to wound dehiscence, infection, skin necrosis, implant exposure and failed reconstruction have been widely reported. We present an innovative approach for immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal matrices with a de-epithelialised dermal sling to protect and support the implant, while improving clinical outcomes in this challenging group of patients.Materials and methodsDemographic, tumour and surgical data were reviewed for patients undergoing Wise pattern (T-scar) skin-reducing mastectomies with immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal matrices with a de-epithelialised dermal sling.ResultsThis technique was successfully employed to reconstruct five large pendulous breasts in four breast cancer patients with a median age of 50.5 years (range 34–61 years) who were not suitable for, or had declined, flap-based reconstruction. The acellular dermal matrices used were SurgiMend®, StratticeTMand Braxon® and the expandable implants were placed in the sub-pectoral (n = 3) and pre-pectoral (n = 1) planes. The technical steps and clinical outcomes are presented. One patient experienced T-junction breakdown overlying the de-epithelialised dermis without implant loss.ConclusionThe combination of an acellular dermal matrix and a dermal sling provides a double-layer ‘water-proofing’ and support for the implants inferiorly, avoiding T-junction breakdown complications, since any dehiscence is on to well-vascularised dermis. Furthermore, the acellular dermal matrix stabilises the implant in the large mastectomy cavity (pocket control). This approach provides a viable option which facilitates mastectomy and immediate implant reconstruction in large-breasted patients.
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Tork, Shahryar, Ryan C. Jefferson, and Jeffrey E. Janis. "Acellular Dermal Matrices: Applications in Plastic Surgery." Seminars in Plastic Surgery 33, no. 03 (August 2019): 173–84. http://dx.doi.org/10.1055/s-0039-1693019.

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AbstractModern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
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Nahabedian, Maurice Y. "Acellular Dermal Matrices in Primary Breast Reconstruction." Plastic and Reconstructive Surgery 130 (November 2012): 44S—53S. http://dx.doi.org/10.1097/prs.0b013e31825f2215.

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Janis, Jeffrey E., Anne C. OʼNeill, Jamil Ahmad, Toni Zhong, and Stefan O. P. Hofer. "Acellular Dermal Matrices in Abdominal Wall Reconstruction." Plastic and Reconstructive Surgery 130 (November 2012): 183S—193S. http://dx.doi.org/10.1097/prs.0b013e3182605cfc.

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Dissertations / Theses on the topic "Acellular dermal matrices"

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Tognetti, Linda. "Development of new acellular lyophilized dermal matrices for advanced wound healing." Doctoral thesis, Università di Siena, 2020. http://hdl.handle.net/11365/1116557.

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Though a great variety of dermal matrices and skin equivalents are available, either synthetic and semisynthetic, viable human skin allografts are still considered the most physiological alternative to autologous skin in hard-to-heal wounds. Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, lower legs) are particularly challenging and can often be delayed due to local and systemic factors. In these cases, integrated medical-surgical approach based on the use of dermal acellular matrices should be considered. Skin bank are tissue establishments dedicated to the procurement, processing and distribution of human-derived skin bioproducts for clinical purposes. In the Skin Bank of Siena, we developed and validated 4 new different bioproducts based on cadaver skin donation, including: deep-frozen de-epidermized dermis (DED), deep-frozen reticular dermis (DER), lyophilized DED and lyophilized DER. By acting as a physiological scaffold, these products add several advantages, such as significant control of pain and exudate, protection of deep structures (e.g. tendons, bones, cartilage and nerves), stimulation of a functional new dermis (rather than a scar) and re-epithelization with relevant reduction of wound closure time.
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Nair, Rekha. "Acellular matrices derived from differentiating embryonic stem cells." Diss., Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/37170.

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Embryonic stem cells (ESCs) can differentiate into all somatic cells, and as such, are a promising cell source for therapeutic applications. In vitro, ESCs spontaneously differentiate via the aggregation of cells into embryoid bodies (EBs), which recapitulate aspects of early embryogenesis and harbor a unique reservoir of cues critical for tissue formation and morphogenesis. Embryonic healing responses employ similar intrinsic machinery used for tissue development, and these morphogenic cues may be captured within the EB microenvironment. Recent studies have shown that when injected into injury or defect models in vivo, ESCs synthesize and secrete extracellular factors that ultimately contribute to repair, suggesting that these molecules may be as important for regenerative therapies as functional differentiation of the cells. The overall objective of this project was to develop novel acellular matrices derived from differentiating ESCs undergoing morphogenesis. The central hypothesis was that embryonic matrices contain complex mixtures of extracellular factors that, when isolated, retain bioactivity and enhance wound healing in an adult environment. The overall objective was accomplished by: (1) investigating the production of extracellular matrix (ECM) by differentiating ESCs as a function of differentiation time; (2) assessing the ability of solvents to efficiently decellularize EBs; and (3) evaluating the healing response elicited by acellular matrices derived from EBs in a murine dermal wound healing model. Endogenous ECM synthesis by EBs varied with time and was associated with specific differentiation events. Novel techniques were developed to effectively remove cell components from EBs in order to extract complex, bioactive acellular matrices. EB-derived acellular matrices significantly enhanced the healing of excisional dermal wounds in mice, indicating the potency of extracellular factors synthesized by ESCs. All together, these studies demonstrate that acellular matrices derived from ESCs retain morphogenic factors capable of influencing tissue repair. In addition, this work lays the foundation for future studies to further examine the functional role of endogenous matrix molecules on ESC differentiation and to evaluate the utility of a stem cell-derived matrix for a variety of regenerative medicine applications.
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Pillay, Kamlen. "The use of Acellular Dermal Matrices in the Management of Complex Traumatic Wounds in a Paediatric Population." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32976.

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Introduction Complex soft tissue injuries are common in children. Paediatric wounds associated with large soft tissue defects pose a surgical challenge. This often necessitates extensive reconstructive surgery and frequently requires the use of microvascular free flaps. Local, regional and free flap surgery in children poses several challenges related to donor site morbidity, flap failure and the long-term sequelae of repeated surgeries for flap modification in a growing child. The introduction of acellular dermal matrices (ADM's) in recent decades has dramatically influenced the management of complex soft tissue wounds. The dermis in skin represents the functional aspect of skin. ADM's represent dermal structures artificially, hence their incorporation into the wound should restore skin characteristics specifically pliability. Some authors believe that ADM's have improved prognosis and reduced morbidity in the treatment of open wounds. Combining the use of ADM's together with split-thickness skin grafting (SSG) is rapidly becoming an important method used to manage such complex wounds. In this study, we explore whether the use of this technique has been a beneficial addition to the traditional management armamentarium for complex injuries in the extremities and report the rate of complications experienced by our patients at our paediatric hospital in Cape Town. Objective This study reviewed the number of complications experienced with the use of ADM's in treating complex wounds on the extremities of children. It includes 54 children treated between the years 2011 and 2016 at a national paediatric hospital. Methodology A retrospective folder review of children treated at our hospital between the years 2011 and 2016 with extremity injuries was conducted. A total of 189 patient folders were reviewed. Children (n= 54) with complex wounds in their extremities who had received an ADM were included in this study. Both short and long-term complications were identified. The patient age range was six months - 12 years, while the mean patient follow-up period was 390 days. Results All patients treated with ADMs for traumatic extremity injuries during this period were included in the study, irrespective of age or co-morbidities. In 45 patients the ADM and SSG healed without any complication that is, not requiring revision surgery at 1 year follow up. Seven patients who did not receive postoperative splinting and occupational / physiotherapy displayed wound contractures, requiring further reconstructive surgery, 4 of which were also in the group who experienced complete ADM or graft loss below. Six patients experienced complete loss of the ADM due to infection, which led to graft failure, requiring revision surgery. Of the six patients that experienced complete loss of the ADM, five were not treated with NPWT dressings. Noteworthy, is that all 45 patients who healed without any complication were treated with NPWT dressings. Biopsies that were performed on 18 patients at 2 weeks post application of the ADM, showed only granulation tissue. No evidence of residual ADM or accessory dermal structures was found in any of the samples, which were obtained from multiple loci of the ADM in situ. The mean time to closure with this method was 3 weeks and the mean hospital stay was 26 days. Two patients were lost to follow-up and were excluded from the morbidity analysis arm of the study. Discussion We found that post-operative physiotherapy, occupational therapy and splinting are extremely important in preventing morbidity in particular scar contracture when associated with wounds treated with ADMs. There was no histological evidence to suggest that the ADM remains intact after 2 weeks post application. Our data reveals that vacuum assisted closure is a vital adjunct to this method, ensuring adequate ADM and graft take. Conclusion Complex wounds in the extremities of children pose a reconstructive dilemma to the plastic surgeon. In anatomically sensitive areas where traditional plastic surgery options are unavailable or undesirable, the use of ADMs and SSGs represent a realistic alternative for the reconstruction of large wounds associated with complex soft tissue injuries in the extremities of children.
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Boone, Marc. "High-definition optical coherence tomography: Contribution to the non-invasive near infrared optical imaging techniques of the skin." Doctoral thesis, Universite Libre de Bruxelles, 2016. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/232235.

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Background. The development of non-invasive imaging techniques has been stimulated by the shortcomings of histopathology. Currently the only valid diagnostic technique in dermatology is skin biopsy which remains a painful, invasive intervention for the patient. Moreover, this approach is not always convenient for monitoring and follow-up of a skin disease. Optical imaging technologies could solve these shortcomings as they are fast, precise, repeatable and painless. There are four established non-invasive skin imaging techniques used in daily practice: dermoscopy, high-frequency ultrasound, reflectance confocal microscopy (RCM) and conventional optical coherence tomography (C-OCT). In imaging there is a trade-off between resolution and penetration depth. The former permits the visualization of cells, if the resolution is at least 3 µm. The latter enables the recognition of patterns and structures in deeper layers of the skin if the penetration depth is deeper than 150 µm. New non-invasive techniques using infrared light sources have been developed recently. The technique used in this work is a high-definition optical coherence tomography (HD-OCT).Objectives. The overall aims of this thesis were the feasibility of HD-OCT to visualize in/ex vivo, in real time and in 3-D the cellular and structural morphology of the skin, secondly the assessment of the capability of this technology to measure in vivo and real time the cutaneous optical properties, and finally the determination of the contribution of this technique to the non-invasive near-infrared imaging technologies. Five specific objectives have been established: i) could cells be observed in their 3-D microenvironment in normal and diseased skin, ii) could we describe morphologic features of cells and structures in normal and diseased skin (m_HD-OCT), iii) could these morphologic features be quantified by optical property analysis (o_HD-OCT), iv) was it possible to perform accurate thickness measurements in normal and diseased skin, and finally v) what was the diagnostic potential of this technique?Methodology. HD-OCT uses a combination of parallel time-domain interferometry, high power tungsten lamp (with Gaussian filter, very low lateral coherence and ultra-high bandwidth (1300 nm +/- 100 nm)), and last but not least, full field illumination with real time focus tracking. A constant homogeneous resolution of 3 µm resolution in all three dimensions is obtained up to a depth of 570 µm. Hence, the system is capable of capturing real time full 3-D images. Moreover, the in vivo assessment of optical properties of the skin is only applicable to OCT when operating in focus-tracking mode, which is the case for HD-OCT. The means to obtain answers to the five specific questions were the comparison of en face HD-OCT images with RCM and HD-OCT cross-sectional images with histopathology and C-OCT. Results. At least 160 line pares were observed by imaging a high resolution phantom with HD-OCT. This suggested a 3 µm lateral resolution. The presence of cells such as keratinocytes, melanocytes, inflammatory cells, fibroblasts and melanophages in their 3-D cutaneous microenvironment in vivo as well as ex vivo has been demonstrated .A qualitative description of structures and patterns in normal and diseased skin could be performed by HD-OCT. Clear structural changes of the epidermis, dermo-epidermal junction, papillary dermis and reticular dermis related to intrinsic skin ageing could be observed. Lobulated structures, surrounded by stretched stromal fibers and arborizing vessels, could be demonstrated in nodular basal cell carcinoma (BCC). The o_HD-OCT of normal and diseased skin could be assessed in vivo. This approach permitted the quantitative assessment of the OCT signal attenuation profiles of normal healthy skin, actinic keratosis (AK) and squamous cell carcinoma (SCC). Differences in signal attenuation profiles could be demonstrated between these three groups. These differences were also observed between BCC subtypes. The slope of the exponential attenuation of the signal in the upper part of the epidermis was very high in benign nevi. The more malignant the lesion the lower the slope. Thickness measurements of epidermis and papillary dermis could be performed by m_HD-OCT, based on a cross-sectional images and their corresponding en face image. More accurate measurements of epidermal and papillary dermal thickness could be performed based on the optical analysis of a skin volume by o_HD-OCT. The diagnostic potential of HD-OCT in comparison with dermoscopy, RCM and C-OCT could be assessed regarding i) melanoma, ii) BCC differentiation from BCC imitators and BCC sub-differentiation and iii) SCC differentiation from AK. A much higher diagnostic potential could be demonstrated for o_HD-OCT in comparison with m_HD-OCT concerning melanoma detection. The diagnostic potential of HD-OCT to discriminate BCC from clinical BCC imitators was moderate. However, HD-OCT seemed to have high potential in sub-differentiation of BCC subtypes: i) it seemed to be the best technique to include and exclude a superficial BCC, ii) the technique appeared to be the best approach to exclude nodular BCC, and iii) HD-OCT looked to be the best technique to include an infiltrative BCC. Finally, HD-OCT has proven to be a powerful method to discriminate AK from SCC.Conclusions. HD-OCT is able to capture real time 3-D imaging with a sufficiently high optical resolution and penetration depth to allow the visualization of cells in and ex vivo in their micro-architectural context. At the same time, HD-OCT permits the recognition of patterns and structures in a sufficiently large volume of skin (1.5 mm³). HD-OCT closes therefore the gap between RCM with a high resolution but low penetration depth and C-OCT with a low resolution but high penetration depth. Moreover, HD-OCT permits, in contrast to RCM and C-OCT, the real time in vivo analysis of optical properties of the skin. HD-OCT seems to be a promising tool for early diagnosis of melanoma, BCC sub-differentiation and differentiation between SCC and AK.Future perspectives. Multicenter validation studies are needed to determine the diagnostic performance of this promising new technology, especially in other clinical settings combining both morphological and optical property analysis. This combined analysis could be a valuable method not only for diagnosis, monitoring and therapeutic guidance of dermatologic diseases but it could also be helpful in the management of non-dermatologic conditions such as diabetic micro-angiopathy, infantile cystinosis or even osteoporosis.
Doctorat en Sciences médicales (Santé Publique)
info:eu-repo/semantics/nonPublished
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Books on the topic "Acellular dermal matrices"

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Acellular Dermal Matrices in Breast Surgery an Issue of Clinics in Plastic Surgery. W.B. Saunders Company, 2012.

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Book chapters on the topic "Acellular dermal matrices"

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Nahabedian, Maurice Y. "Acellular Dermal Matrices: To Use or Not?" In Operative Approaches to Nipple-Sparing Mastectomy, 135–46. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-43259-5_13.

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Kronowitz, Steven J. "The Science Behind Fat Grafting and Acellular Dermal Matrices." In Operative Approaches to Nipple-Sparing Mastectomy, 209–15. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-43259-5_20.

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Jones, Glyn. "The Use of Acellular Dermal Matrices in Implant-Based Breast Reconstruction." In Oncoplastic and Reconstructive Breast Surgery, 489–99. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-62927-8_38.

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Jones, Glyn. "The Use of Acellular Dermal Matrices in Implant-Based Breast Reconstruction." In Oncoplastic and Reconstructive Breast Surgery, 227–34. Milano: Springer Milan, 2013. http://dx.doi.org/10.1007/978-88-470-2652-0_23.

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Razdan, Shantanu N., and Colleen M. McCarthy. "The Use of Acellular Dermal Matrices in Two-Stage Expander/Implant Reconstruction." In Breast Reconstruction, 1029–33. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-18726-6_102.

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Wagner, C., R. Owens, J. Harper, and D. Mcquillan. "Human-derived acellular matrices for dermal replacement." In Biomaterials for Treating Skin Loss, 142–73. CRC Press, 2009. http://dx.doi.org/10.1201/9781420099904.ch10.

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Wagner, C. T., R. T. Owens, J. R. Harper, and D. J. McQuillan. "Human-derived acellular matrices for dermal replacement." In Biomaterials for Treating Skin Loss, 142–73. Elsevier, 2009. http://dx.doi.org/10.1533/9781845695545.2.142.

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Carlsson, Anders H., Edward M. Gronet, Lloyd F. Rose, and Rodney Chan. "Clinical Applications of Acellular Dermal Matrices in Reconstructive Surgery." In Skin Tissue Engineering and Regenerative Medicine, 109–24. Elsevier, 2016. http://dx.doi.org/10.1016/b978-0-12-801654-1.00006-1.

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Bush, Katie, and Arthur A. Gertzman. "Process Development and Manufacturing of Human and Animal Acellular Dermal Matrices." In Skin Tissue Engineering and Regenerative Medicine, 83–108. Elsevier, 2016. http://dx.doi.org/10.1016/b978-0-12-801654-1.00005-x.

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Suh, Hyunsuk, and Joon Pio. "One Stage Allogenic Acellular Dermal Matrices (ADM) and Split-Thickness Skin Graft with Negative Pressure Wound Therapy." In Skin Grafts. InTech, 2013. http://dx.doi.org/10.5772/53304.

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Conference papers on the topic "Acellular dermal matrices"

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De Deyne, P. G., T. Diab, and M. Sandor. "A Study on the Mechanical Properties of Acellular Dermal Matrices and Their Interface Properties After Implantation in an Acute Abdominal Wall Defect in a Primate." In ASME 2013 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/sbc2013-14339.

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Within Regenerative Medicine, non-cell-based approaches such as biologically-derived materials have been commercially successful and represent an important proportion of medically-used biomaterials1. Several acellular matrices are commercially available, to be used as a reinforcement of soft tissue where weakness exists. The goal of this study was to determine whether out-of-package mechanical properties of an acellular tissue matrix was predictive of its in vivo interface strength and whether the in vivo interface strength was associated with a particular histological response. We chose to test three porcine dermis-derived acellular matrices and one bovine pericardium derived matrix.
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TERZINI, MARA, ALESSANDRA ALDIERI, CRISTINA BIGNARDI, ELISABETTA M. ZANETTI, and ALBERTO L. AUDENINO. "EQUI-BIAXIAL TESTS FOR MECHANICAL CHARACTERIZATION OF HUMAN ACELLULAR DERMAL MATRICES THROUGH A CUSTOM-MADE BIAXIAL FIXTURE." In MATERIALS CHARACTERISATION 2017. Southampton UK: WIT Press, 2017. http://dx.doi.org/10.2495/mc170401.

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Reports on the topic "Acellular dermal matrices"

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Saldanha, Ian J., Wangnan Cao, Justin M. Broyles, Gaelen P. Adam, Monika Reddy Bhuma, Shivani Mehta, Laura S. Dominici, Andrea L. Pusic, and Ethan M. Balk. Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis. Agency for Healthcare Research and Quality (AHRQ), July 2021. http://dx.doi.org/10.23970/ahrqepccer245.

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Objectives. This systematic review evaluates breast reconstruction options for women after mastectomy for breast cancer (or breast cancer prophylaxis). We addressed six Key Questions (KQs): (1) implant-based reconstruction (IBR) versus autologous reconstruction (AR), (2) timing of IBR and AR in relation to chemotherapy and radiation therapy, (3) comparisons of implant materials, (4) comparisons of anatomic planes for IBR, (5) use versus nonuse of human acellular dermal matrices (ADMs) during IBR, and (6) comparisons of AR flap types. Data sources and review methods. We searched Medline®, Embase®, Cochrane CENTRAL, CINAHL®, and ClinicalTrials.gov from inception to March 23, 2021, to identify comparative and single group studies. We extracted study data into the Systematic Review Data Repository Plus (SRDR+). We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42020193183). Results. We found 8 randomized controlled trials, 83 nonrandomized comparative studies, and 69 single group studies. Risk of bias was moderate to high for most studies. KQ1: Compared with IBR, AR is probably associated with clinically better patient satisfaction with breasts and sexual well-being but comparable general quality of life and psychosocial well-being (moderate SoE, all outcomes). AR probably poses a greater risk of deep vein thrombosis or pulmonary embolism (moderate SoE), but IBR probably poses a greater risk of reconstructive failure in the long term (1.5 to 4 years) (moderate SoE) and may pose a greater risk of breast seroma (low SoE). KQ 2: Conducting IBR either before or after radiation therapy may result in comparable physical well-being, psychosocial well-being, sexual well-being, and patient satisfaction with breasts (all low SoE), and probably results in comparable risks of implant failure/loss or need for explant surgery (moderate SoE). We found no evidence addressing timing of IBR or AR in relation to chemotherapy or timing of AR in relation to radiation therapy. KQ 3: Silicone and saline implants may result in clinically comparable patient satisfaction with breasts (low SoE). There is insufficient evidence regarding double lumen implants. KQ 4: Whether the implant is placed in the prepectoral or total submuscular plane may not be associated with risk of infections that are not explicitly implant related (low SoE). There is insufficient evidence addressing the comparisons between prepectoral and partial submuscular and between partial and total submuscular planes. KQ 5: The evidence is inconsistent regarding whether human ADM use during IBR impacts physical well-being, psychosocial well-being, or satisfaction with breasts. However, ADM use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections not explicitly implant related (low SoE). Whether or not ADM is used probably is associated with comparable risks of seroma and unplanned repeat surgeries for revision (moderate SoE for both), and possibly necrosis (low SoE). KQ 6: AR with either transverse rectus abdominis (TRAM) or deep inferior epigastric perforator (DIEP) flaps may result in comparable patient satisfaction with breasts (low SoE), but TRAM flaps probably increase the risk of harms to the area of flap harvest (moderate SoE). AR with either DIEP or latissimus dorsi flaps may result in comparable patient satisfaction with breasts (low SoE), but there is insufficient evidence regarding thromboembolic events and no evidence regarding other surgical complications. Conclusion. Evidence regarding surgical breast reconstruction options is largely insufficient or of only low or moderate SoE. New high-quality research is needed, especially for timing of IBR and AR in relation to chemotherapy and radiation therapy, for comparisons of implant materials, and for comparisons of anatomic planes of implant placement.
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Journal articles
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