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A Head-to-head Comparison between SurgiMend and Epiflex in 127 Breast Reconstructions.

Eichler C, Vogt N, Brunnert K, Sauerwald A, Puppe J, Warm M - Plast Reconstr Surg Glob Open (2015)

Bottom Line: Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%).This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates.Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.

View Article: PubMed Central - PubMed

Affiliation: Breast Center, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Senology, Clinic for Senology, Osnabrueck, Germany; Department of Gynecology and Obstetrics, Hospital Düren GmbH, Düren, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.

ABSTRACT

Background: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 2400 ADM reconstructions. Nonetheless, head-to-head comparisons between SurgiMend and Epiflex are not yet reported. In fact, this is the first clinical data report on the use of Epiflex. This work will, therefore, compare postoperative complication rates and costs for these ADMs.

Methods: This analysis is a retrospective review of a single surgeon's 6-year experience with both SurgiMend-an acellular bovine dermal collagen matrix for soft-tissue reconstruction and Epiflex-a decellularized human skin tissue from 2008 to 2013.

Results: One hundred patients had a total of 127 implant-based reconstructions using SurgiMend (64 cases; 50.4%) or Epiflex (63 cases; 49.6%). Gross complication rates were 11.1% for SurgiMend and 40.6% for Epiflex including hematoma, postoperative skin irritation, infection, necrosis, and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%).

Conclusions: This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates. Severe complication rates are comparable with those reported in literature for both products. Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.

No MeSH data available.


Related in: MedlinePlus

A, Presurgical image. The patient had received nipple sparing, bilateral subcutaneous mastectomies with immediate implant-based reconstruction. The esthetic thoracic wall/breast transition was insufficient, and revision was desired. B, Six-month postsurgical image shows this prepectoral reconstruction where SurgiMend was used in the upper quadrant to optimize esthetic thoracic wall/breast transition. Adequate, complication-free surgical outcome was achieved. C, Presurgical image before a nipple sparing, bilateral subcutaneous mastectomy. D, Six-month postsurgical image for a subpectoral Epiflex assisted reconstruction where the ADM has been used to cover the implant in the lower breast pole in a hammock-type situation. Adequate, complication-free surgical outcome was achieved.
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Figure 1: A, Presurgical image. The patient had received nipple sparing, bilateral subcutaneous mastectomies with immediate implant-based reconstruction. The esthetic thoracic wall/breast transition was insufficient, and revision was desired. B, Six-month postsurgical image shows this prepectoral reconstruction where SurgiMend was used in the upper quadrant to optimize esthetic thoracic wall/breast transition. Adequate, complication-free surgical outcome was achieved. C, Presurgical image before a nipple sparing, bilateral subcutaneous mastectomy. D, Six-month postsurgical image for a subpectoral Epiflex assisted reconstruction where the ADM has been used to cover the implant in the lower breast pole in a hammock-type situation. Adequate, complication-free surgical outcome was achieved.

Mentions: Implant-based reconstruction of SSM procedures may, however, present its own problems. Some may be solved using an ADM. Their use has become an attractive option in implant-based breast reconstruction, and an increasing number of publications is becoming available, currently including over 2400 ADM reconstructions (both synthetic and biological). Promising results were shown when ADMs were used in soft-tissue replacement, additional implant coverage, and fixation of the pectoralis major muscle. Furthermore, increased implant stability may be achieved by introducing a lower pole ADM hammock type situation. The main goal of ADM-assisted implant-based breast reconstruction is improving coverage of the implant, implant site stability, and fixation of the pectoralis muscle (Fig. 1). Therefore, there is a need to evaluate the clinical benefit of the use of ADMs. Although there seems to be some literature evidence of differing complication rates because of different ADMs, no direct comparison of the fetal bovine ADM—SurgiMend8,9 and the decellularized human skin tissue product—Epiflex2,10 has been published so far.


A Head-to-head Comparison between SurgiMend and Epiflex in 127 Breast Reconstructions.

Eichler C, Vogt N, Brunnert K, Sauerwald A, Puppe J, Warm M - Plast Reconstr Surg Glob Open (2015)

A, Presurgical image. The patient had received nipple sparing, bilateral subcutaneous mastectomies with immediate implant-based reconstruction. The esthetic thoracic wall/breast transition was insufficient, and revision was desired. B, Six-month postsurgical image shows this prepectoral reconstruction where SurgiMend was used in the upper quadrant to optimize esthetic thoracic wall/breast transition. Adequate, complication-free surgical outcome was achieved. C, Presurgical image before a nipple sparing, bilateral subcutaneous mastectomy. D, Six-month postsurgical image for a subpectoral Epiflex assisted reconstruction where the ADM has been used to cover the implant in the lower breast pole in a hammock-type situation. Adequate, complication-free surgical outcome was achieved.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494509&req=5

Figure 1: A, Presurgical image. The patient had received nipple sparing, bilateral subcutaneous mastectomies with immediate implant-based reconstruction. The esthetic thoracic wall/breast transition was insufficient, and revision was desired. B, Six-month postsurgical image shows this prepectoral reconstruction where SurgiMend was used in the upper quadrant to optimize esthetic thoracic wall/breast transition. Adequate, complication-free surgical outcome was achieved. C, Presurgical image before a nipple sparing, bilateral subcutaneous mastectomy. D, Six-month postsurgical image for a subpectoral Epiflex assisted reconstruction where the ADM has been used to cover the implant in the lower breast pole in a hammock-type situation. Adequate, complication-free surgical outcome was achieved.
Mentions: Implant-based reconstruction of SSM procedures may, however, present its own problems. Some may be solved using an ADM. Their use has become an attractive option in implant-based breast reconstruction, and an increasing number of publications is becoming available, currently including over 2400 ADM reconstructions (both synthetic and biological). Promising results were shown when ADMs were used in soft-tissue replacement, additional implant coverage, and fixation of the pectoralis major muscle. Furthermore, increased implant stability may be achieved by introducing a lower pole ADM hammock type situation. The main goal of ADM-assisted implant-based breast reconstruction is improving coverage of the implant, implant site stability, and fixation of the pectoralis muscle (Fig. 1). Therefore, there is a need to evaluate the clinical benefit of the use of ADMs. Although there seems to be some literature evidence of differing complication rates because of different ADMs, no direct comparison of the fetal bovine ADM—SurgiMend8,9 and the decellularized human skin tissue product—Epiflex2,10 has been published so far.

Bottom Line: Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%).This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates.Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.

View Article: PubMed Central - PubMed

Affiliation: Breast Center, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Senology, Clinic for Senology, Osnabrueck, Germany; Department of Gynecology and Obstetrics, Hospital Düren GmbH, Düren, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.

ABSTRACT

Background: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 2400 ADM reconstructions. Nonetheless, head-to-head comparisons between SurgiMend and Epiflex are not yet reported. In fact, this is the first clinical data report on the use of Epiflex. This work will, therefore, compare postoperative complication rates and costs for these ADMs.

Methods: This analysis is a retrospective review of a single surgeon's 6-year experience with both SurgiMend-an acellular bovine dermal collagen matrix for soft-tissue reconstruction and Epiflex-a decellularized human skin tissue from 2008 to 2013.

Results: One hundred patients had a total of 127 implant-based reconstructions using SurgiMend (64 cases; 50.4%) or Epiflex (63 cases; 49.6%). Gross complication rates were 11.1% for SurgiMend and 40.6% for Epiflex including hematoma, postoperative skin irritation, infection, necrosis, and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%).

Conclusions: This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates. Severe complication rates are comparable with those reported in literature for both products. Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.

No MeSH data available.


Related in: MedlinePlus