plastic surgery and acellular dermal matrix: highlighting trends from 1999 to 2013

the last decade has ushered in a rapidly expanding global discussion regarding acellular dermal matrix (adm) applications, economic analyses, technical considerations, benefits, and risks, with recent emphasis on adm use in breast surgery. this study aims to evaluate global trends in adm research using bibliometric analysis. the top nine plastic surgery journals were determined by impact factor (if). each issue of the nine journals between 1999 and 2013 was accessed to compile a database of articles discussing adm. publications were further classified by if, authors’ geographic location, study design, and level of evidence (loe, i-v). productivity index and productivity share were calculated for each region. in total, 256 adm articles were accessed. the annual global publication volume increased significantly by 4.2 (0.87) articles per year (p<0.001), with a mean productivity index of 36.3 (59.0). the mean impact factor of the nine journals increased significantly from 0.61 (0.11) to 2.47 (0.99) from 1993 to 2013 (p<0.001). despite this increase in the global adm literature, the majority of research was of weaker loe (level i: 2.29% and level ii: 9.17%). usa contributed the most research (87%), followed by asia (4.76%) and western europe (4.71%). usa contributed the greatest volume of research. regarding clinical application of adm, the majority of publications focused on adm use in breast surgery, specifically breast reconstruction (154 articles, 60.2%). the majority of research was of lower loe; thus, efforts should be made to strengthen the body of literature, particularly with regard to cost analysis.