title: Is Sterile Better Than Aseptic? Comparing the Microbiology of Acellular Dermal Matrices.
abstract: BACKGROUND
  Postoperative infections are a major complication associated with tissue-expander-based breast reconstruction. The use of acellular dermal matrix (ADM) in this surgery has been identified as a potential reservoir of infection, prompting the development of sterile ADM. Although aseptic and sterile ADMs have been investigated, no study has focused on the occurrence and clinical outcome of bacterial colonization before implantation.
  
  
  METHODS
  Samples of aseptic AlloDerm, sterile Ready-To-Use AlloDerm, and AlloMax were taken before implantation. These samples were incubated in Tryptic soy broth overnight before being streaked on Trypticase soy agar, MacConkey agar, and 5% blood agar plates for culture and incubated for 48 hours. Culture results were cross-referenced with patient outcomes for 1 year postoperatively.
  
  
  RESULTS
  A total of 92 samples of ADM were collected from 63 patients. There were 15 cases of postoperative surgical site infection (16.3%). Only 1 sample of ADM (AlloMax) showed growth of Escherichia coli, which was likely a result of contamination. That patient did not develop any infectious sequelae. Patient outcomes showed no difference in the incidence of seroma or infection between sterile and aseptic ADMs.
  
  
  CONCLUSIONS
  This study evaluates the microbiology of acellular dermal matrices before use in breast reconstruction. No difference was found in the preoperative bacterial load of either aseptic or sterile ADM. No significant difference was noted in infection or seroma formation. Given these results, we believe aseptic processing used on ADMs is equivalent to sterile processing in our patient cohort in terms of clinical infection and seroma occurrence postoperatively.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Klein
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Nasser
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Phillips
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gersch
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Fourman
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Sarit E
authors.initials: SE
authors.lastname: Lilo
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Fritz
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Sami U
authors.initials: SU
authors.lastname: Khan
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Dagum
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
authors.forename: Duc T
authors.initials: DT
authors.lastname: Bui