Document Detail


Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques.
MedLine Citation:
PMID:  19819774     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Latissimus dorsi harvest and axillary surgery can affect shoulder function. The effect of autologous latissimus dorsi flap (ALD) breast reconstruction and donor site quilting have been inadequately studied. A cohort of ALD flap breast reconstruction patients were assessed pre-operatively and at eight post-operative time-points (up to 3 years after reconstruction) using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, for which validated normative data is available. Patients with incidental shoulder conditions and bilateral reconstructions were excluded. This was a prospective, observational study with blinded data interpretation: 58 patients, 22 of whom had donor site quilting, were assessed. Groups were compatible demographically, in breast care management and in pre-operative DASH score (quilted 6.5, non-quilted 6.4; P=0.98). Scores were significantly increased at initial post-operative clinic review (mean 49, SD19; P<0.001), 6 week (29, SD20; P<0.001), and 3 month (19, SD19; P<0.01), thereafter remaining at a plateau value of approximately 15 (P>0.05). Seroma incidence was reduced in the quilted group (5% vs 70%). A strong, significant correlation was found between 3 month DASH score and long term function (r=0.66, P<0.0003); patients with DASH >20 fare significantly worse in the longterm (mean 20 point increase, SD5.0, P<0.001). Higher post-operative DASH scores correlated significantly with pre-operative DASH (r=0.58) and BMI (r=0.36). Adjuvant therapy had no effect on shoulder function. Axillary dissection had a weak correlation with a higher DASH score, but only at the 3-month post-operative time-point (r=0.32, P=0.03). ALD flap breast reconstruction generally results in a functionally insignificant increase (6.5 points) in longterm DASH score, although a small subset of patients do develop longterm impairment, and quilting does not appear to inhibit shoulder function.
Authors:
J Button; J Scott; R Taghizadeh; E Weiler-Mithoff; A M Hart
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-10-12
Journal Detail:
Title:  Journal of plastic, reconstructive & aesthetic surgery : JPRAS     Volume:  63     ISSN:  1878-0539     ISO Abbreviation:  J Plast Reconstr Aesthet Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-06     Completed Date:  2010-10-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264239     Medline TA:  J Plast Reconstr Aesthet Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1505-12     Citation Subset:  IM    
Copyright Information:
Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. Jane.Button@ggc.scot.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Axilla / surgery
Breast Neoplasms / surgery*,  therapy
Disability Evaluation
Female
Humans
Mammaplasty / methods*
Middle Aged
Muscle, Skeletal / transplantation*
Physical Therapy Modalities
Postoperative Complications / epidemiology
Prospective Studies
Seroma / epidemiology
Shoulder / physiopathology*,  surgery*
Statistics, Nonparametric
Surgical Flaps*
Suture Techniques*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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