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The Use Of Acellular Dermal Matrix In Breast And Abdominal Wall Surgery: A Meta-Analysis Of Outcomes And Risk Factors Predictive Of Complications
Oluwaseun A. Adetayo, MD, Samuel E. Salcedo, BA, Subhas C. Gupta, MD, PhD.
Loma Linda University Medical Center, Loma Linda, CA, USA.

PURPOSE:
The use of acellular dermal matrix (ADM) has gained widespread acceptance in breast and abdominal wall reconstructions since its development in 1994. In breast reconstructive surgery, it is used as an inferolateral hammock to provide additional coverage and capsular reinforcement in this region. In the abdominal surgical field, ADM is desirable to synthetic mesh alternatives due to the lower risk of adhesions and infection, and better incorporation into the surrounding tissues. Despite its widespread use, there is currently a wide variation regarding outcome rates in the literature and risk factors predictive of complications. The current study definitively elucidates the complication rates associated with ADM use in breast and abdominal wall surgery and identifies significant risk factors predisposing to the development of these complications.
METHODS:
A literature search was conducted using the Medline database (PubMed, U.S. National Library of Medicine) and The Cochrane Library for publications involving the use of ADM. A total of 464 articles were identified, of which 53 were eligible based on the study’s inclusion and exclusion criteria set forth for the use of ADM in breast and abdominal surgery. A meta-analysis was performed with the following endpoints of interest: incidence of seroma, cellulitis, infection, wound dehiscence, implant failure, and hernia recurrence. The effect of certain risk factors such as smoking, radiation, chemotherapy, and diabetes on the development of these complications is also evaluated.
RESULTS:
A majority of the studies were retrospective (68.6%). Mean follow-up was 15.2 months (SD ± 10.1 months). The overall risk of complications associated with ADM use were as follows: seroma formation: 8%, cellulitis: 5.1%, wound infection: 16.1%, wound dehiscence: 8.1%, breast implant failure: 6.1%, hernia: 27.6%, and abdominal bulging: 28.1%. Risk of infection despite the administration of antibiotics was 36.4% in abdominal cases compared to 9.1% in breast cases. Radiation resulted in a significant difference in the rates of cellulitis (p=0.021) and chemotherapy was associated with a higher incidence of seroma formation (p=0.014). There was no statistically significant difference noted with respect to the effect of diabetes or smoking on development of seroma, cellulitis, wound infection, or implant failure.
CONCLUSION:
This study is the first to evaluate the overall complication rates associated with ADM use by conducting a meta-analysis of published data to date. This will afford physicians a single comprehensive source of reference when undergoing informed consent discussion with patients. In addition, identifying the risk factors associated with ADM use will enable physicians to identify patients at higher risk for complications prior to the performance of surgical procedures.


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