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Our goal is to characterize the ultrastructure at the interface of two textured expanders (Allergan BIOCELL® and Mentor SILTEX®) and an Acellular Dermal Matrix Alloderm®, through a prospective randomized study, using scanning electron microscopy.
Methods
We prospectively included who had a two stages breast reconstruction with an acelullar dermal matrix Alloderm®. Five patients had a Mentor Siltex® expander and 5 had an Allergan Biocell ® expander.
Two 1 cm2 periprosthetic capsule specimens were sampled en bloc with the implant during expander to permanent implant exchange. One at the junction between Alloderm® and the pectoralis major muscle and one at the site of Alloderm ® All samples were analyzed under SEM using High Vacuum (HiVac) modes and Energy dispersive X-ray (EDX) studies. Observations were charted in order to tally and objectivise three parameters: texture/cellularity /presence of biofilm and bacteria
These measurements were performed using Adobe Photoshop software (Adobe® Photoshop® CS6 Extended). This software allows for measurements of distance between two points on an image with a 2% margin of error
Results:
In Group 1: Biocell®/Alloderm ®, We found no macro texture ingrowth of the capsule on the pores of the textured implants (Velcro-effect) at the implant-matrix interface. And a strong bacterial colonization of the implant porous surface, with presence of biofilm in 3 cases.
In group 2 Siltex® / Alloderm ®, we found a smooth capsule surface but significantly less bacterial and no biofilm development
Conclusion
The lack of Velcro effect on the Biocell® implant in front of Alloderm ®, facilitate bacterial seeding, propagation and the formation of a biofilm in 3 of the specimens.
The findings can help guide clinical decision making with regards to selecting the most optimal implant surface when employing an acelullar dermal matrix, in order to minimize long-term complications.