Is Porcine Acellular Dermis An Effective Alternative for Abdominal Reconstruction After Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction?

“Is Porcine Acellular Dermis an Effective Alternative for Abdominal Reconstruction after Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction?”

 

BACKGROUND: Approximately 70,000 women in the United States undergo breast reconstruction after mastectomy annually, with the pedicle TRAM flap still a popular choice for these patients. It has been reported that approximately 8% of patients who undergo a pedicle TRAM flap procedure develop an abdominal hernia or bulge. Many techniques have been used to reduce this occurrence, but the use of bioprosthetics such as Permacol to close the anterior rectus fascia defect has become popular in our department at UTMB. Since the use of this product has not been examined closely, we examined the efficacy of Permacol in reducing abdominal hernias and bulges postoperatively in pedicle TRAM flap patients.

METHODS: Through retrospective chart review, data was collected on 44 patients who had undergone a pedicle TRAM flap procedure in the last 15 years, 21 of whom having received Permacol placement and 23 receiving primary closure of the abdominal site without the use of prolene mesh or overlay grafts. Data included age, BMI, race, comorbidities, surgical details, complications, and average follow-up, among others. Using statistical analyses, we compared the rate of complications in patients who underwent primary closure to those who received Permacol placement.

RESULTS: Average patient age was 50.14 in the Permacol group and 51.43 in the primary closure group. Average BMI was 29.86 in the Permacol group and 28.87 in the primary closure group. There was no significant difference in either race or comorbidities.  We found no significant differences in any complications between groups, most importantly with respect abdominal hernias and bulges. There was also no difference in the occurrence of abdominal complications between patients who had undergone previous abdominal surgery and those who did not.

CONCLUSIONS: From our results, we must conclude that Permacol does not provide the abdominal strength necessary for most patients to maintain abdominal wall laxity, regardless of previous abdominal surgery. Also, previous abdominal surgery does not increase the occurrence or abdominal complicaitions. Further studies are needed with larger sample sizes to determine the effectiveness of this product compared to others such as Marlex (prolene mesh), Alloderm, etc.