Human Acellular Dermis Increases Surgical Site Infection and Overall Complication Profile When Compared with Submuscular Breast Reconstruction: An Updated Meta-Analysis Incorporating New Products

Publication date: Available online 6 July 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): J. Michael Smith, Justin M. Broyles, Ying Guo, Sami H. Tuffaha, David Mathes, Justin M. Sacks

ABSTRACT

Background

Human acellular dermal matrix (HADM) is an increasingly used adjunct to breast reconstruction. Previous meta-analysis demonstrate increased risks of complications, but these studies represent largely represent one product. The purpose of this study is to stratify outcomes based on a meta-analysis of complications incorporating all new studies after 2012 and their associated new human-based products.

Methods

A query of the MEDLINE database for articles on HADM and breast reconstruction from 1/2012 to 10/2015 yielded 172 citations. Two levels of screening identified 47 relevant studies. Thirteen studies were used in comparative meta-analysis.

Results

Complication rates were higher in HADM patients: total complications, 17.7 versus 6.1 %; seroma, 8.3 versus 5.4 %; infection, 7.2 versus 5.9 %; and flap necrosis, 14.7 versus 7.1 %.

Meta-analysis revealed a statistically significant increased risk of total complications in patients undergoing reconstruction with HADM when compared with their submuscular cohort (p = 0.03; RR = 1.46; CI: 1.04-2.04). Patients undergoing reconstruction with HADM demonstrated a significantly increased risk of flap necrosis (p < 0.01; RR = 2.39; CI: 1.8-3.16) and infection (p=0.02; RR = 1.5; CI: 1.07-2.09) when compared with submuscular reconstruction. There was no significant difference in seroma, hematoma, or implant explantation between these two groups.

Conclusions

This study suggests an increased risk of overall complications, specifically infection and flap necrosis, in patients undergoing tissue expander/implant breast reconstruction with HADM when compared with submuscular placement. This must be weighed against the advantages in enhancing aesthetic outcomes, increasing intraoperative fill volume, and ameliorating capsular contracture.