440 Consecutive immediate, implant-based, single-surgeon breast reconstructions in 281 patients: a comparison of early outcomes and costs between SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices.

BACKGROUND: A 2010 nationwide survey of plastic and reconstructive surgeons indicated that approximately 83 percent performed predominantly implant-based breast reconstruction, with acellular dermal matrix used by approximately half of those practitioners. Although the medical literature documents well over 2000 cases of breast reconstruction with matrices, relatively few cases using other than human cadaveric acellular dermal matrices have been reported. The author compared complications and costs using SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices. METHODS: A retrospective review of a single surgeon's 5-year experience was performed for consecutive, nonrandomized immediate breast reconstructions with acellular dermal matrix from 2005 to 2010. RESULTS: Two hundred eighty-one patients had 440 implant-based reconstructions using SurgiMend [222 patients (79.0 percent)] or AlloDerm [59 patients (21.0 percent)]. No significant differences in complication rates were observed between SurgiMend and AlloDerm for hematoma, infection, major skin necrosis, or breast implant removal. Seroma was the most prevalent complication; the seroma rate for AlloDerm (15.7 percent) was significantly greater than that for SurgiMend (8.3 percent). Using recent product costs for equivalently sized AlloDerm and SurgiMend units, the cost of SurgiMend was $1024 less per breast than AlloDerm. CONCLUSIONS: SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices demonstrate similar rates of major early complications in breast reconstruction in this study. This similarity in complication rates between SurgiMend and AlloDerm and the cost savings seen with the use of SurgiMend are factors for the surgeon to consider in choosing a matrix for breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, III.

Comparison of a series of superficial chemical peels with a single midlevel chemical peel for the correction of facial actinic damage.

BACKGROUND: Chemical facial peels are common cosmetic procedures that have gained in popularity over the last decade. OBJECTIVE: The aim of this study was to compare the efficacy and morbidity of a series of superficial glycolic acid (GA) peels with those of a midlevel trichloroacetic acid (TCA) peel. METHODS: We conducted a split-face study of 7 female patients, comparing the benefits of a single 35% TCA peel with those of a series of 5 30% GA peels performed at monthly intervals. Throughout the study, we performed noninvasive biophysical measurements, optical imaging, and expert and naïve image evaluations and conducted subject-group discussions so that we might objectively quantify and compare the treatments over time. An additional objective of the research was to use quantitative objective measurements of skin condition and actinic damage to establish these techniques as biologically based standards for treatment evaluation. RESULTS: Skin elasticity and hydration increased during the course of the study but were not significantly different between the 2 treatment modes. Overall improvement with both treatments was relatively small as judged by expert evaluations of digital images taken at baseline and 3 months after treatment. No important differences were perceived when naïve judges were asked to evaluate the images. Digital-image analysis of wrinkles in the cheek region revealed significantly greater improvement in wrinkles with the TCA peel. In patient-group discussions, TCA peels were associated with greater improvement but also with more discomfort; GA peels were associated with a high degree of satisfaction, although their effect on quantitative technical measures of actinic damage was not dramatic. CONCLUSIONS: Although a single TCA peel produced more improvement than a series of superficial peels, the differences were small, and the TCA peel was associated with significantly greater discomfort.