TY - JOUR

T1 - Donor-site morbidity following breast reconstruction with a latissimus dorsi flap – A prospective study

AU - Højvig, Jens H.

AU - Henriksen, Marius

AU - Bartholdy, Cecilie R.

AU - Bonde, Christian T.

N1 - Funding Information: The study was approved by the Danish Data Protection Agency and the Regional Health Research Ethics Committee (jr.nr. H-2014–075). No financial disclosures Publisher Copyright: © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons

PY - 2022

Y1 - 2022

N2 - Introduction: Despite a trend toward the use of perforator-based flaps for autologous breast reconstruction, the m. latissimus dorsi (LD) flap remains a popular alternative. Several studies have sought to uncover the shoulder-related donor-site morbidity, but the results are inconclusive. This study aims at evaluating what impact breast reconstruction with an LD flap has on shoulder strength, range of motion (ROM), lymphedema, sensory disturbances, and patients’ ability to perform activities of daily living (ADL). Materials and methods: In a prospective observational study, we examined 20 female patients undergoing delayed breast reconstruction with an LD flap. The primary outcome was a change in shoulder strength, measured with the Biodex System4 Pro-dynamometer. ROM was assessed using two-dimensional photogrammetry. Furthermore, the patients’ self-reported pain, lymphedema, sensory disturbances, and ability to perform ADL were assessed using a questionnaire. Measurements were performed pre-operatively at 3 months and 12 months post-operatively. Results: Of the 20 included patients, 17 completed the follow-up. At the 12 months follow-up, a significant loss of isometric shoulder strength of 17% was observed in shoulder adduction (P<0.001) and 21% in extension (P<0.001). Isometric strength and ability to perform ADL and ROM were unchanged. There was a decrease in the number of patients reporting problems with lymphedema (10 to 7) and an increase in the incidence of sensory disturbances (10 to 13). Conclusion: A loss of shoulder strength was observed following the transfer of the LD flap; however, the procedure did not hinder the post-operative performance of ADLs for the patients. LD reconstruction seems to be a safe procedure.

AB - Introduction: Despite a trend toward the use of perforator-based flaps for autologous breast reconstruction, the m. latissimus dorsi (LD) flap remains a popular alternative. Several studies have sought to uncover the shoulder-related donor-site morbidity, but the results are inconclusive. This study aims at evaluating what impact breast reconstruction with an LD flap has on shoulder strength, range of motion (ROM), lymphedema, sensory disturbances, and patients’ ability to perform activities of daily living (ADL). Materials and methods: In a prospective observational study, we examined 20 female patients undergoing delayed breast reconstruction with an LD flap. The primary outcome was a change in shoulder strength, measured with the Biodex System4 Pro-dynamometer. ROM was assessed using two-dimensional photogrammetry. Furthermore, the patients’ self-reported pain, lymphedema, sensory disturbances, and ability to perform ADL were assessed using a questionnaire. Measurements were performed pre-operatively at 3 months and 12 months post-operatively. Results: Of the 20 included patients, 17 completed the follow-up. At the 12 months follow-up, a significant loss of isometric shoulder strength of 17% was observed in shoulder adduction (P<0.001) and 21% in extension (P<0.001). Isometric strength and ability to perform ADL and ROM were unchanged. There was a decrease in the number of patients reporting problems with lymphedema (10 to 7) and an increase in the incidence of sensory disturbances (10 to 13). Conclusion: A loss of shoulder strength was observed following the transfer of the LD flap; however, the procedure did not hinder the post-operative performance of ADLs for the patients. LD reconstruction seems to be a safe procedure.

KW - Breast reconstruction

KW - Flap surgery

KW - Latissimus dorsi

KW - LD breast reconstruction

KW - Plastic surgery

KW - Reconstructive surgery

U2 - 10.1016/j.bjps.2022.01.036

DO - 10.1016/j.bjps.2022.01.036

M3 - Journal article

C2 - 35183466

AN - SCOPUS:85124715524

VL - 75

SP - 2205

EP - 2210

JO - Journal of plastic, reconstructive & aesthetic surgery : JPRAS

JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS

SN - 1748-6815

IS - 7

ER -