title: Impact of Acellular Dermal Matrix (ADM) Use Under Mastectomy Flap Necrosis on Perioperative Outcomes of Prosthetic Breast Reconstruction.
abstract: BACKGROUND
  There is conflicting data on the potential necrotic complications of acellular dermal matrix (ADM) use in breast reconstruction, and most studies focus on mastectomy flap necrosis as an outcome measure associated with ADM use. The aim of this study was to examine cases with necrotic complications with and without the use of ADM and to investigate whether ADM affected perioperative outcomes in cases with necrotic complications.
  
  
  METHODS
  Patients who experienced mastectomy flap necrosis following mastectomy with tissue expander placement between January 2009 and March 2015 were retrospectively reviewed. The primary outcome was explantation of the expander, and other associated outcomes such as seroma or infection were also recorded.
  
  
  RESULTS
  A total of 57 breasts with mastectomy flap necrosis were identified: 32 of which were in the non-ADM group and 25 in the ADM group. The rate of explantation was 28% (7/25) in the ADM group versus 6.3% (2/32) in the non-ADM group, which was significantly different (P = 0.034). The ADM group had a significantly higher rate of "major" infection requiring surgical debridement than the non-ADM group (P = 0.016). Multivariate analysis showed that the use of ADM was trending toward an increasing expander rate with borderline significance (P = 0.05).
  
  
  CONCLUSIONS
  This study demonstrated that ADM use under mastectomy flap necrosis was a potential risk for explantation of the expander and major infection. Surgeons should be cautious with the use of ADM with devascularized mastectomy skin flaps prone to necrosis.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 81, Gangnam-gu, Seoul, 06351, South Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 81, Gangnam-gu, Seoul, 06351, South Korea. si55.bang@samsung.com.
authors.forename: Sa Ik
authors.initials: SI
authors.lastname: Bang
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects*; D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods; D001943:Breast Neoplasms / Q000601:surgery; D020878:Device Removal; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology / Q000628:therapy; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology*; D015626:Tissue Expansion / Q000009:adverse effects* / Q000295:instrumentation; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Acellular derma matrix; Mastectomy flap necrosis; Prosthetic breast reconstruction