The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex®, Strattice® and Braxon®, in immediate implant-based subpectoral breast reconstruction cases. Background: The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. Methods: 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice® acellular dermal matrix (SADM), 22 cases Epiflex® acellular dermal matrix (EADM) and the remaining 35 cases Braxon® acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). Results: The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Brax-on® matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon® ADM showed a significantly lower time

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ZusammenfassungDie Pectoralis-Muskellappenplastik ist zur Deckung sternaler Defekte nach tiefer sternaler Wundinfektion weit verbreitet. Sie kann entweder als klassischer Advancement-Flap, gestielt an der A. thoracoacromialis, oder als Turnover-Flap, gestielt an den interkostalen Perforatoren der A. thoracica interna, gehoben werden. Der Advancement-Flap hat den Nachteil, dass eine Bedeckung des inferioren Sternumdrittels oft nicht erzielt werden kann, während der Turnover-Flap zwar das inferiore und mediale Drittel bedeckt, oft aber im kranialen Drittel nicht ausreicht. Die Autoren beschreiben eine neuartige Methode zum Breitengewinn der Turnover-Pectoralis-Lappenplastik durch Aufsplitten dieser entlang der Muskelfasern.Bei allen zwölf Patienten, die zwischen 2017 und 2022 mit dieser Methode behandelt wurden, konnte eine vollständige Abheilung sowie ein Wundverschluss erzielt werden. Die Split-Pectoralis-Lappenplastik stellt damit eine sichere und effektive Methode zur Defektdeckung sternaler Defekte dar.