Retrospective Analysis Of Clinical Cases Of Acellular Allogeneic Dermal Matrix

Objectives1.To summarize the clinical cases and applications of acellular dermal matrix used in the department of Plastic Surgery in Peking Union Medical College Hospital;2.To confirm the correlation between acellular dermal matrix and its postoperative complications;3.To clarify the postoperative complications and the secondary surgery of breast reconstruction surgery assisted with acellular dermal matrix after breast cancer surgery;4.To identify the patients who will benefit from the breast reconstruction surgery assisted with acellular dermal matrix and the patients who will suffer from the complications of the surgery with acellular dermal matrix.MethodsThis study is a single-center retrospective cohort study.The basic information of patients who used J-1 acellular dermal matrix in the department of Plastic Surgery of Peking Union Medical College Hospital from January,2019 to June,2020 was compiled and counted.Firstly,the clinical applications of ADM in plastic surgery is summarized.Then the preoperative and postoperative photos,surgical records,other clinical information and follow-up records of typical clinical cases are collected.Secondly,statistics about postoperative complications of ADM related breast cancer cases including infection,seroma,capsular contracture,poor wound healing,flap necrosis and prosthesis exposure were collected.Additionally,whether there are secondary surgeries including flap repair surgery and prosthesis remove surgery was also recorded.The different clinical features of patients who used ADM to do the breast reconstruction surgery was also collected and analyzed.SPSS is used to do statistical analysis of risk factors for complications of acellular dermal matrix-assisted surgery.ResultsA total of 84 ADM related cases were included,including 31 cases of breast reconstruction surgery,11 cases of breast suspension surgery,5 cases of chest wall reconstruction,15 cases of abdominal wall reconstruction,11 cases of facial plastic surgery,4 cases of vaginal tightening surgery,5 cases of composite skin grafting surgery,1 case of repairing pelvic floor fascia surgery and 1 case of repairing thigh fascia.Thirteen patients had postoperative complications,including postoperative infection 8.3%,poor wound healing 8.3%,wound splitting 3.6%,seroma 2.3%and death 1.2%.No capsule contracture was found.The rate of secondary surgery was 8.3%.There were 34 patients ADM related breast reconstruction after breast cancer surgery.9 had postoperative complications(26.5%),and 7 were admitted in hospital to do the secondary surgery(20.6%),including 2 cases of prosthesis removal.Implant volume is an independent risk factor for postoperative complications of ADM-related breast reconstruction surgery(OR=1.016,95%CI:1.003-1.030,p<0.05).Operation time is a protective factor for postoperative complications of ADM-related breast reconstruction surgery(OR=0.971,95%CI:0.945-0.998,p<0.01).Conclusions:Although acellular dermal matrix has been applied in many clinical aspects,its safety still needs to be concerned.Patients undergoing breast reconstruction surgery with ADM have a high risk of postoperative complications.Surgeons are supposed to fully evaluate the feasibility and safety of patients using ADM before operation.Further case-control studies and expansion of the sample are required.The risk factors associated with each postoperative complication must be confirmed by binary logistic regression analysis.