Are All Acellular Dermal Matrices (ADMs) Created Equal? Results from a Multicenter Prospective Study
Katherine B. Santosa, MD1, Katelyn G. Bennett, MD1, Ji Qi, MS1, Hyungjin M. Kim, ScD1, Jennifer B. Hamill, MPH1, Andrea L. Pusic, MD, MHS2, Adeyiza O. Momoh, MD1, Edwin G. Wilkins, MD, MS1.
1University of Michigan, Ann Arbor, MI, USA, 2Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Acellular dermal matrix (ADM) has allowed for significant advances in immediate breast reconstruction. With its increasingly widespread use, different types have become available. In a single center, retrospective cohort study, we previously demonstrated important outcome differences across brands of ADM: Specifically, patients reconstructed with FlexHD had higher rates of major infection than those with AlloDerm. In this study, we used a multicenter, prospective cohort to compare complication rates across common types of ADM.
With patients recruited from 11 sites, we compared complications of immediate reconstructions using AlloDerm, FlexHD and other products (i.e. AlloMax, SERI Scaffold, SurgiMend, Biodesign, and Vicryl). Complications including hematoma, seroma, mastectomy flap necrosis, wound infection, wound dehiscence, and reconstructive failure were analyzed using hierarchical logistic regression models, accounting for study centers and controlling for a range of demographic and clinical variables.
Of the 810 patients included in our cohort, 507 patients (62.6%) were reconstructed with AlloDerm, 128 patients (15.8%) with FlexHD, and 175 patients (21.6%) with another type of material (i.e. AlloMax, SERI Scaffold, Biodesign, SurgiMend, or Vicryl). Patients with FlexHD were significantly more likely to suffer an infection (OR, 2.79; 95% CI, 1.07 to 7.26; p=0.036), reconstructive failure (OR, 3.3; 95% CI, 1.40 to 7.56; p=0.006), and any complication (OR, 2.80; 95% CI, 1.63 to 4.80; p=0.000) than those patients reconstructed with AlloDerm.
Patients undergoing immediate implant-based breast reconstruction with FlexHD had significantly increased odds of developing infection, reconstructive failure, and any sort of complication compared to those reconstructed with AlloDerm.
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