Fenestration Improves Acellular Dermal Matrix Biointegration: An Investigation of Revascularization with Photoacoustic Microscopy.

Background: Acellular dermal matrices (ADMs) have revolutionized alloplastic breast reconstruction. Furthering our knowledge of ADM biointegration will allow for improved design of these biomaterials. The ideal ADM for breast reconstruction would provide durable soft tissue augmentation while undergoing rapid biointegration to promote physiologic elasticity and reduced infectious complications. The inclusion of fenestrations in the design of ADMs is thought to promote the process of biointegration; however, the mechanisms underlying this theory have not been evaluated. Methods: Biointegration of standard and fenestrated ADMs was assessed with serial photoacoustic microscopy (PAM) imaging, in a murine dorsal skin-fold window chamber model that is specifically designed to recapitulate the microenvironment of ADM–assisted alloplastic breast reconstruction. PAM allows for a serial, real-time noninvasive assessment of hemoglobin content and oxygen saturation in living tissues; generating high-resolution, three-dimensional maps of the nascent microvasculature within ADMs. Confirmatory histology and immunohistochemical assessments were performed at the terminal time point. Results: Fenestrated ADMs demonstrated increased fibroblast and macrophage lineage host cell infiltration, greater mean percent surface area vascular penetration (21% vs 11%, p=0.08), and greater mean oxygen saturation (13.5% vs 6.9%, p

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