Acellular Dermal Matrix Sterility: Does It Affect Microbial and Clinical Outcomes Following Implantation?

Area of Science:

• Plastic Surgery
• Biomaterials Science
• Microbiology

Background:

• Acellular dermal matrices (ADMs) are used in breast reconstruction, but their sterilization methods and impact on infectious complications remain debated.
• Previous research indicated no immediate difference between aseptic and sterilized ADMs, but post-implantation microbial profiles were unexamined.

Purpose of the Study:

• To investigate the microbiologic profiles of acellular dermal matrices (ADMs) after implantation in breast reconstruction.
• To determine if ADM sterilization methods correlate with infectious complications post-implantation.

Main Methods:

• A prospective study involving the collection and culturing of 51 acellular dermal matrix (ADM) samples from 32 patients undergoing tissue expander-based breast reconstruction.
• Samples were excised during stage II expander-implant exchange and incubated to assess microbial growth. Patient records were analyzed for correlations between sterilization, microbial growth, and infectious complications.

Main Results:

• No bacterial growth was observed in any of the 51 cultured acellular dermal matrix (ADM) samples, irrespective of sterilization level (aseptic, 10-3, or 10-6).
• Only one patient experienced a postoperative infectious complication out of 32 patients.
• No statistically significant correlation was found between ADM sterilization method, microbial presence, and postoperative infectious complications.

Conclusions:

• The study found no difference in microbial presence or clinical outcomes between differently sterilized acellular dermal matrices (ADMs) after implantation.
• The absence of bacterial growth in post-implantation samples challenges the routine necessity for terminal sterilization of ADMs in breast reconstruction.
• Further research may clarify the role and optimal processing of ADMs in reconstructive surgery.