Page 266 - Read Online
P. 266

but was associated with the pectoralis major migrating   compare meshed versus un-meshed ADM is pending.
            superiorly and causing window shading. In addition, as
            the inferior pole  is covered solely by a thin skin flap,   Financial support and sponsorship
            there  is  a  risk  of implant  migration,  poor visibility,   Nil.
            palpability,  and excessive  ptosis.  Window shading has
            since been corrected with marionette sutures to anchor   Conflicts of interest
            the pectoralis major, while the development of alloderm
            helped with the problem of lower pole coverage. [2]  There are no conflicts of interest.
            Meshing of alloderm is an innovative idea that can decrease   REFERENCES
            the costs of its use. A recent study looked at the effects
            of fenestrating ADMs.  Their results showed that with   1.   Gabriel A, Maxwell GP. Evolving role of alloderm in breast surgery. Plast
                              [8]
            fenestrations, the incidence of capsular contractures,   Surg Nurs 2011;31:141-50.
            infections and seroma formation were all decreased. Further,   2.   Shimizu R, Kishi K. Skin graft. Plast Surg Int 2012;2012:563493.
            they  described  improved  intra-operative  fill  volumes  and   3.   Jansen LA, De Caigny P, Guay NA, Lineaweaver WC, Shokrollahi K. The
                                                                  evidence base for the acellular dermal matrix alloderm: a systematic
            expansion rate, as well as a decreased number of post-  review. Ann Plast Surg 2013;70:587-94.
            operative expansions.  While not identical in technique to   4.   Chauviere MV, Schutter RJ, Steigelman MB, Clark BZ, Grayson JK, Sahar
                             [8]
            meshing alloderm, it does show potential further benefits   DE. Comparison of alloderm and allomax tissue incorporation in rats.
            for meshing alloderm. By employing a similar technique   Ann Plast Surg 2014;73:282-5.
            used with split thickness skin grafts, we were able to take   5.   Glasberg SB, Light D. AlloDerm and strattice in breast reconstruction: a
            a standard 6 cm × 17 cm sheet of alloderm and increase   comparison and techniques for optimizing outcomes. Plast Reconstr Surg
            its area from 102 cm  to 153 cm , an increase of 50%. In our   6.   2012;129:1223-33.
                                     2
                            2
                                                                  Wu  C,  Cipriano  J,  Osgood  G, Tepper  D,  Siddiqui A.  Human  acellular
            experience, with an increase of 50% more alloderm available   dermal  matrix (AlloDerm®) dimensional changes  and  stretching in
            for use, this amounted to savings of approximately 50% per   tissue expander/implant breast reconstruction. J Plast Reconstr Aesthet
            sheet of alloderm. Intraoperative findings during the second   Surg 2013;66:1376-81.
            stage (expander to implant exchange) show that the meshed   7.   Dumont  CE, Domenghini C, Kessler  J. Donor  site morbidity after
            alloderm integrates as well if not better than the standard   serratus anterior free muscular flap: a prospective clinical study. Ann
            unmeshed alloderm. This may be because the overall three-  Plast Surg 2004;52:195-8.
            dimensional surface area of the ADM is increased, allowing   8.   Mowlds DS, Salibian AA, Scholz T, Paydar  KZ, Wirth GA. Capsular
                                                                  contracture in implant-based breast reconstruction: examining the
            for better integration and neovascularization. Further   role of acellular dermal matrix fenestrations.  Plast Reconstr Surg
            correlation with histological analysis and clinical follow up to   2015;136:629-35.








































            256                                                                Plast Aesthet Res || Volume 3 || July 14, 2016
   261   262   263   264   265   266   267   268   269   270   271