Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study

BACKGROUND

Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described.

OBJECTIVES

To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT.

METHODS

We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center. Patients were categorized into four cohorts: ADM, ADM with PMRT, non-ADM, and non-ADM with PMRT. Outcomes and complications were compared among cohorts.

RESULTS

Over 10 years, 957 patients underwent ITE reconstruction (683 non-ADM, 113 non-ADM with PMRT, 486 ADM, and 88 ADM with PMRT) with 1370 reconstructions. Overall complication rates for the ADM and non-ADM cohorts were 39.0% and 16.7%, respectively (P < 0.001). Within both cohorts, mastectomy skin flap necrosis (MSFN) was the most common complication, followed by infection. ADM use was associated with a significantly higher rate of infections and seromas in both radiated and non-radiated groups; however, when comparing radiated cohorts, the incidence of explantation was significantly lower with the use of ADM.

CONCLUSIONS

The decision to use ADM for expander-based breast reconstruction should be performed with caution, given higher overall rates of complications, including infections and seromas. There may, however, be a role for ADM in cases requiring PMRT, as the overall incidence of implant failure is lower than non-ADM cases.

LEVEL OF EVIDENCE: 3

Laparoscopic resection of splenic artery aneurysms

BACKGROUND

Laparoscopic techniques used to manage asymptomatic splenic artery aneurysms have been reported infrequently.

METHODS

A laparoscopic splenic artery aneurysm resection was attempted for six consecutive patients.

RESULTS

One patient underwent conversion to laparotomy because of a tear in the splenic vein. Among the five successful laparoscopic splenic artery aneurysm resections, the mean estimated blood loss was 37 +/- 12.6 ml, the mean operative time was 187.6 +/- 79.2 min, and the mean postoperative length of hospital stay was 1.8 +/- 1.3 days. The mean time to a clear liquid diet was 5.3 +/- 0.5 h, and the mean time to a regular diet was 1 +/- 0 day. The mean duration of narcotic analgesic use was 5.4 +/- 1.5 days, and the mean time to resumption of regular activities was 12.7 +/- 1.6 days.

CONCLUSIONS

These cases illustrate the benefit of a laparoscopic approach with brief hospitalizations, early resumption of diet and regular activity, and minimal use of postoperative narcotic analgesics.

A reappraisal of the caloric requirements of men

The resting metabolic rates (RMR) of 60 lean and obese men, aged 18-82 y and weighing 60-171 kg, were measured and body compositions were determined. Body compositional variables reflecting active protoplasmic tissue were all highly interrelated. Body weight alone gave prediction values for RMR that were comparable to those of other variables of active protoplasmic tissue mass. Regional distribution of fat had no influence on the RMR and the influence of age on RMR was trivial. The classic prediction equations and tables overestimate RMR of men. The 95%-confidence limits for both lean and obese men were broad. This conclusively demonstrates that metabolic efficiency is not necessarily or exclusively related to obesity. New regression equations for predicting the RMR based on weight and fat-free mass were developed: RMR = 879 + 10.2 WT kg and RMR = 290 + 22.3 FFMD kg, where FFMD is fat-free mass from densitometry measurements.