The Experts below are selected from a list of 13341 Experts worldwide ranked by ideXlab platform
Charles E Butler - One of the best experts on this subject based on the ideXlab platform.
-
bovine versus porcine acellular Dermal Matrix a comparison of mechanical properties
Plastic and reconstructive surgery. Global open, 2014Co-Authors: David Matthew Adelman, Jesse C Selber, Charles E ButlerAbstract:Despite being classified together as acellular Dermal matrices (ADMs), biologic mesh devices vary widely in both origin and processing. They are derived from numerous sources (human, porcine, bovine, etc.) and tissues (dermis, intestine or bladder submucosa, pericardium, etc.), are decellularized by distinct proprietary methods, and are sterilized by one of several techniques (gamma irradiation, electron beam irradiation, ethylene oxide, etc.).1,2 The result of this diversity is materials with inherently different biochemistries, mechanical properties,2 and host responses upon implantation.3,4 As clinical outcomes in hernia repair can be associated with biomechanical properties, it is reasonable to expect that outcomes might be different for different materials. For example, the use of human acellular Dermal Matrix has been almost completely abandoned for use in hernia repair due to overwhelming evidence that it leads to unacceptably high rates of hernia recurrence and bulge.3,5 Despite this, there is a paucity of data that directly compares the initial, preimplant mechanical properties of commercially available ADMs. A recently published clinical study compared the use of porcine acellular Dermal Matrix (PADM) and bovine acellular Dermal Matrix (BADM) in a retrospective cohort of complex abdominal wall reconstructions (AWRs).6 The study demonstrated a low overall hernia recurrence rate of 3.3% over the approximately 1.8-year mean follow-up, which was similar between the PADM and BADM groups.6 However, intraoperative device failures (IDFs), characterized by tearing of mesh and suture pulling through mesh, were observed in a number of patients who underwent AWR with PADM (10.1%), whereas none were reported in those with BADM (0%).6 The goal of this study is to directly compare the mechanical properties of PADM and BADM to help elucidate the contributory role of mesh selection as a potential cause of previously reported device failures in complex AWR.
-
bovine versus porcine acellular Dermal Matrix for complex abdominal wall reconstruction
Plastic and Reconstructive Surgery, 2013Co-Authors: Mark W Clemens, Jesse C Selber, Jun Liu, David Matthew Adelman, Donald P Baumann, Patrick B Garvey, Charles E ButlerAbstract:BACKGROUND: Abdominal wall reconstruction with bioprosthetic mesh is associated with lower rates of mesh infection, fistula formation, and mesh explantation than reconstruction with synthetic mesh. The authors directly compared commonly used bioprosthetic meshes in terms of clinical outcomes and complications. METHODS: A database of consecutive patients who underwent abdominal wall reconstruction with porcine or bovine acellular Dermal Matrix and midline musculofascial closure at their institution between January of 2008 and March of 2011 was reviewed. Surgical outcomes were compared. RESULTS: One hundred twenty patients were identified who underwent a nonbridged, inlay abdominal wall reconstruction with porcine [69 patients (57.5 percent)] or bovine acellular Dermal Matrix (51 patients (42.5 percent)]. The mean follow-up time was 21.0 ± 9.9 months. The overall complication rate was 36.6 percent; the porcine Matrix group had a significantly higher complication rate (44.9 percent) than the bovine Matrix group (25.5 percent; p = 0.04) and statistically equivalent surgical complications (29.2 percent versus 21.6 percent; p = 0.34). There were no significant differences in rates of recurrent hernia (2.9 percent versus 3.9 percent; p = 0.99) or bulge (7.2 percent versus 0 percent; p = 0.07). However, the rate of intraoperative adverse events in the porcine Matrix group [seven events (10.1 percent)] was significantly higher than that in the bovine Matrix group (0 percent; p = 0.02). CONCLUSIONS: In patients who undergo complex abdominal wall reconstruction, both bovine and porcine acellular Dermal Matrix are associated with similar rates of postoperative surgical complications and appear to result in similar outcomes. Porcine acellular Dermal Matrix may be prone to intraoperative device failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
-
metrics of cellular and vascular infiltration of human acellular Dermal Matrix in ventral hernia repairs
Plastic and Reconstructive Surgery, 2012Co-Authors: Kristin Turza Campbell, Nadja K Burns, Joe Ensor, Charles E ButlerAbstract:Background Human acellular Dermal Matrix (HADM) is used for ventral hernia repair, as it resists infection and remodels via surrounding tissue. However, the tissue source and impact of basement membrane (BM) on cell and vessel infiltration have not been determined. We hypothesized that musculofascia would be the primary tissue source of cells and vessels infiltrating into HADM and the BM would inhibit infiltration.
-
human versus non cross linked porcine acellular Dermal Matrix used for ventral hernia repair comparison of in vivo fibrovascular remodeling and mechanical repair strength
Plastic and Reconstructive Surgery, 2011Co-Authors: Kristin Turza Campbell, Nadja K Burns, Carmen N Rios, Anshu Bagga Mathur, Charles E ButlerAbstract:Background:Human acellular Dermal Matrix (HADM) and non-cross-linked porcine acellular Dermal Matrix (ncl-PADM) are clinically useful for complex ventral hernia repair. Direct comparisons between the two in vivo are lacking, however. This study compared clinically relevant early outcomes with these
-
complex torso reconstruction with human acellular Dermal Matrix long term clinical follow up
Plastic and Reconstructive Surgery, 2009Co-Authors: Nicole L Nemeth, Charles E ButlerAbstract:SUMMARY Although reports have demonstrated good early outcomes with human acellular Dermal Matrix even when used for complex, contaminated defects, no long-term outcomes have been reported. The authors reviewed the long-term outcomes of 13 patients who had complex torso reconstructions that included human acellular Dermal Matrix. All patients were at increased risk for mesh-related complications. Eight patients died as a result of progression of their oncologic disease at a mean of 258 days postoperatively. The mean follow-up for the remaining five patients was 43.7 months. Six patients had early complications (none were human acellular Dermal Matrix-related) and were reported on previously. Two patients had developed complications since the initial report. One patient developed a flap donor-site seroma remote from the reconstruction site, and another developed a recurrent ventral hernia. No patients have required additional surgery for human acellular Dermal Matrix-related complications. This follow-up report indicates that human acellular Dermal Matrix repair of large, complex torso defects can result in good long-term outcomes even when patients are at high risk for mesh-related complications.
Laura J Esserman - One of the best experts on this subject based on the ideXlab platform.
-
the effects of acellular Dermal Matrix in expander implant breast reconstruction after total skin sparing mastectomy results of a prospective practice improvement study
Plastic and Reconstructive Surgery, 2012Co-Authors: Anne Warren Peled, Robert D Foster, Elisabeth R Garwood, Dan H Moore, Cheryl Ewing, Michael Alvarado, Shelley E Hwang, Laura J EssermanAbstract:BACKGROUND: Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular Dermal Matrix nor a strategy for optimal acellular Dermal Matrix selection criteria has been well described. METHODS: Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular Dermal Matrix) comprised 90 cases in which acellular Dermal Matrix was not used. Cohort 2 (consecutive acellular Dermal Matrix) included the next 100 consecutive cases, which all received acellular Dermal Matrix. Cohort 3 (selective acellular Dermal Matrix) consisted of the next 260 cases, in which acellular Dermal Matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis. RESULTS: The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no-acellular Dermal Matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular Dermal Matrix in irradiated patients. CONCLUSIONS: Acellular Dermal Matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
-
the effects of acellular Dermal Matrix in expander implant breast reconstruction after total skin sparing mastectomy results of a prospective practice improvement study
Plastic and Reconstructive Surgery, 2012Co-Authors: Anne Warren Peled, Robert D Foster, Elisabeth R Garwood, Dan H Moore, Cheryl Ewing, Michael Alvarado, Shelley E Hwang, Laura J EssermanAbstract:Background Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular Dermal Matrix nor a strategy for optimal acellular Dermal Matrix selection criteria has been well described. Methods Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular Dermal Matrix) comprised 90 cases in which acellular Dermal Matrix was not used. Cohort 2 (consecutive acellular Dermal Matrix) included the next 100 consecutive cases, which all received acellular Dermal Matrix. Cohort 3 (selective acellular Dermal Matrix) consisted of the next 260 cases, in which acellular Dermal Matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis. Results The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no-acellular Dermal Matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular Dermal Matrix in irradiated patients. Conclusions Acellular Dermal Matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy. Clinical question/level of evidence Therapeutic, III.
Mark W Clemens - One of the best experts on this subject based on the ideXlab platform.
-
bovine versus porcine acellular Dermal Matrix for complex abdominal wall reconstruction
Plastic and Reconstructive Surgery, 2013Co-Authors: Mark W Clemens, Jesse C Selber, Jun Liu, David Matthew Adelman, Donald P Baumann, Patrick B Garvey, Charles E ButlerAbstract:BACKGROUND: Abdominal wall reconstruction with bioprosthetic mesh is associated with lower rates of mesh infection, fistula formation, and mesh explantation than reconstruction with synthetic mesh. The authors directly compared commonly used bioprosthetic meshes in terms of clinical outcomes and complications. METHODS: A database of consecutive patients who underwent abdominal wall reconstruction with porcine or bovine acellular Dermal Matrix and midline musculofascial closure at their institution between January of 2008 and March of 2011 was reviewed. Surgical outcomes were compared. RESULTS: One hundred twenty patients were identified who underwent a nonbridged, inlay abdominal wall reconstruction with porcine [69 patients (57.5 percent)] or bovine acellular Dermal Matrix (51 patients (42.5 percent)]. The mean follow-up time was 21.0 ± 9.9 months. The overall complication rate was 36.6 percent; the porcine Matrix group had a significantly higher complication rate (44.9 percent) than the bovine Matrix group (25.5 percent; p = 0.04) and statistically equivalent surgical complications (29.2 percent versus 21.6 percent; p = 0.34). There were no significant differences in rates of recurrent hernia (2.9 percent versus 3.9 percent; p = 0.99) or bulge (7.2 percent versus 0 percent; p = 0.07). However, the rate of intraoperative adverse events in the porcine Matrix group [seven events (10.1 percent)] was significantly higher than that in the bovine Matrix group (0 percent; p = 0.02). CONCLUSIONS: In patients who undergo complex abdominal wall reconstruction, both bovine and porcine acellular Dermal Matrix are associated with similar rates of postoperative surgical complications and appear to result in similar outcomes. Porcine acellular Dermal Matrix may be prone to intraoperative device failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
-
acellular Dermal Matrix in irradiated tissue expander implant based breast reconstruction evidence based review
Plastic and Reconstructive Surgery, 2012Co-Authors: Mark W Clemens, Steven J KronowitzAbstract:Background:The benefits of acellular Dermal Matrix for breast reconstruction have been well described. However, its clinical impact for breast reconstruction in the setting of radiation therapy has not been well reported.Methods:The MEDLINE and EMBASE databases were reviewed for articles published b
-
acellular Dermal Matrix for the treatment and prevention of implant associated breast deformities
Plastic and Reconstructive Surgery, 2011Co-Authors: Scott L Spear, Mitchel Seruya, Mark W Clemens, Steven Teitelbaum, Maurice Y NahabedianAbstract:Background Acellular Dermal Matrix has been increasingly accepted in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and the suggestion of a decreased capsular contracture rate. Based on this positive experience, it is not surprising that acellular Dermal Matrix would be applied to other challenging implant-related problems. This study investigates the use of acellular Dermal Matrix for correction or prevention of implant-associated breast deformities. Methods Patients who underwent primary aesthetic breast surgery or secondary aesthetic or reconstructive breast surgery using acellular Dermal Matrix and implants between November of 2003 and October of 2009 were reviewed retrospectively. Patient demographics, indications for acellular Dermal Matrix, and acellular Dermal Matrix type and inset pattern were identified. Preoperative and postoperative photographs, success or failure of the procedure, complications, and need for related or unrelated revision surgery were recorded. Results Fifty-two patients had acellular Dermal Matrix placed alongside 77 breast prostheses, with a mean follow-up of 8.6 months (range, 0.4 to 30.4 months). Indications included prevention of implant bottoming-out (n = 6), treatment of malposition (n = 32), rippling (n = 20), capsular contracture (n = 16), and skin flap deficiency (n = 16). Seventy-four breasts (96.1 percent) were managed successfully with acellular Dermal Matrix. Three failures consisted of one breast with bottoming-out following treatment of capsular contracture, one breast with major infection requiring device explantation, and one breast with recurrent rippling. There was a 9.1 percent total complication rate, consisting of three mild infections, one major infection necessitating explantation, one hematoma, and one seroma. Conclusion Based on this experience in 77 breasts, acellular Dermal Matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft-tissue thinning.
Edwin G Wilkins - One of the best experts on this subject based on the ideXlab platform.
-
acellular Dermal Matrix in immediate expander implant breast reconstruction a multicenter assessment of risks and benefits
Plastic and Reconstructive Surgery, 2017Co-Authors: Michael Sorkin, Andrea L Pusic, Hyungjin Myra Kim, Jennifer B Hamill, Jeffrey H Kozlow, Edwin G WilkinsAbstract:Background:Acellular Dermal Matrix has gained widespread acceptance in immediate expander/implant reconstruction because of perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed th
-
use of acellular Dermal Matrix in postmastectomy breast reconstruction are all acellular Dermal matrices created equal
Plastic and Reconstructive Surgery, 2015Co-Authors: Kavitha Ranganathan, Edwin G Wilkins, Katherine B Santosa, Daniel A Lyons, Simanjit Mand, Kelley M Kidwell, David L Brown, Adeyiza O MomohAbstract:Background:AlloDerm and FlexHD are two types of acellular Dermal matrices commonly used in implant-based reconstruction. Although the use of acellular Dermal Matrix has revolutionized immediate breast reconstruction in the setting of breast cancer, it remains unclear which type of acellular Dermal m
-
the impact of acellular Dermal Matrix on tissue expander implant loss in breast reconstruction an analysis of the tracking outcomes and operations in plastic surgery database
Plastic and Reconstructive Surgery, 2013Co-Authors: Christopher J Pannucci, Anuja K Antony, Edwin G WilkinsAbstract:BACKGROUND: Use of acellular Dermal Matrix in breast reconstruction has been associated with increased complications. However, existing studies are generally small, from single centers, and underpowered to control for confounding using regression techniques. Here, the Tracking Outcomes and Operations in Plastic Surgery database was used to examine the effect of acellular Dermal Matrix on expander/implant loss when controlling for other confounders. METHODS: Analysis was limited to patients having tissue expander or implant-based breast reconstruction. Surgeon-reported data, International Classification of Diseases, Ninth Edition codes, and Current Procedural Terminology codes were used to identify independent variables. The dependent variable of interest was 30-day rates of tissue expander or implant loss. Bivariate statistics were performed. Multivariable logistic regression identified independent predictors of expander/implant loss when controlling for other confounders. RESULTS: Data were available for 14,249 patients. The overall rate of expander/implant loss was 2.05 percent. Bivariate analysis demonstrated acellular Dermal Matrix was associated with an absolute increase in expander/implant loss of 0.7 percent (1.88 percent versus 2.58 percent, p = 0.012). The regression model demonstrated that rising body mass index, current smoking, and presence of diabetes were each independent predictors of expander/implant loss. When controlling for all other identified confounders, use of acellular Dermal Matrix was associated with a significant increase in expander/implant loss (odds ratio, 1.42; 95 percent confidence interval, 1.04 to 1.94; p = 0.026). CONCLUSIONS: Thirty-day risk for expander/implant loss after tissue expander or implant-based breast reconstruction was 2.05 percent. Use of acellular Dermal Matrix was associated with a 0.7 percent absolute risk increase for expander/implant loss. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Anne Warren Peled - One of the best experts on this subject based on the ideXlab platform.
-
the effects of acellular Dermal Matrix in expander implant breast reconstruction after total skin sparing mastectomy results of a prospective practice improvement study
Plastic and Reconstructive Surgery, 2012Co-Authors: Anne Warren Peled, Robert D Foster, Elisabeth R Garwood, Dan H Moore, Cheryl Ewing, Michael Alvarado, Shelley E Hwang, Laura J EssermanAbstract:BACKGROUND: Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular Dermal Matrix nor a strategy for optimal acellular Dermal Matrix selection criteria has been well described. METHODS: Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular Dermal Matrix) comprised 90 cases in which acellular Dermal Matrix was not used. Cohort 2 (consecutive acellular Dermal Matrix) included the next 100 consecutive cases, which all received acellular Dermal Matrix. Cohort 3 (selective acellular Dermal Matrix) consisted of the next 260 cases, in which acellular Dermal Matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis. RESULTS: The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no-acellular Dermal Matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular Dermal Matrix in irradiated patients. CONCLUSIONS: Acellular Dermal Matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
-
the effects of acellular Dermal Matrix in expander implant breast reconstruction after total skin sparing mastectomy results of a prospective practice improvement study
Plastic and Reconstructive Surgery, 2012Co-Authors: Anne Warren Peled, Robert D Foster, Elisabeth R Garwood, Dan H Moore, Cheryl Ewing, Michael Alvarado, Shelley E Hwang, Laura J EssermanAbstract:Background Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular Dermal Matrix nor a strategy for optimal acellular Dermal Matrix selection criteria has been well described. Methods Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular Dermal Matrix) comprised 90 cases in which acellular Dermal Matrix was not used. Cohort 2 (consecutive acellular Dermal Matrix) included the next 100 consecutive cases, which all received acellular Dermal Matrix. Cohort 3 (selective acellular Dermal Matrix) consisted of the next 260 cases, in which acellular Dermal Matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis. Results The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no-acellular Dermal Matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular Dermal Matrix in irradiated patients. Conclusions Acellular Dermal Matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy. Clinical question/level of evidence Therapeutic, III.