Acellular dermis is widely used in prosthesis based breast reconstruction, however, there is a lack of data concerning its expandability and related skin changes. This experimental study in rats aimed to determine whether acellular dermis could be expanded and whether the histological changes occurring in the skin with tissue expansion is different from normal when acellular dermis is used. The results indicated a number of interesting findings. Firstly, there was a significant increase in total skin thickness and decrease in epidermal thickness when acellular dermis was used alongside tissue expansion, compared to when it was not. Skin integrity and skin structure for the acellular dermis group was similar to the control group (no tissue expander). Secondly, significantly increased vascularity was demonstrated with the use of acellular dermis. This is in accordance with the existing literature and is advantageous for skin quality. Lastly, the acellular dermis remained in its initial dimensions and did not follow skin expansion. These results led the authors to suggest that, although acellular dermis doesn’t expand itself, as it supports normal skin structure, it may give use to overinflated, bigger expanders. They also suggest that acellular dermis application might have a preventative effect for skin thinning related complications during tissue expansion. It was concluded that with its skin preserving and vascular inducing properties, acellular dermis can be beneficial in implant based breast reconstruction, in terms of morbidity and its tissue support. 

The effect of skin expansion on acellular dermis in an experimental model.
Karadag TG, Aral AM, Tuncer S, et al.
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Clara Smith

NHS Greater Glasgow & Clyde, UK

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