| Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. | |
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MedLine Citation:
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PMID: 19819774 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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J Button; J Scott; R Taghizadeh; E Weiler-Mithoff; A M Hart |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-10-12 |
Journal Detail:
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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:
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Created Date: 2010-09-06 Completed Date: 2010-10-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101264239 Medline TA: J Plast Reconstr Aesthet Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1505-12 Citation Subset: IM |
Copyright Information:
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Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. |
Affiliation:
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Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. Jane.Button@ggc.scot.nhs.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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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