Yoshihiro Sowa1, Toru Morihara2,3, Rie Kushida2,3, Koichi Sakaguchi4, Tetsuya Taguchi4, Toshiaki Numajiri5. 1. Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan. sowawan@kpu-m.ac.jp. 2. Department of Orthopaedics, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan. 3. Department of Rehabilitation, University Hospital, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan. 4. Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan. 5. Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
Abstract
BACKGROUND: Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3 years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT). METHODS: Eighteen patients who underwent unilateral transfer of a pedicled LDM flap and PRT within 2 months of breast-conserving surgery were enrolled in this study. Range of motion (ROM) and muscle strength in exhaustive shoulder movements were measured before surgery, and at 3 and 6 months, and 1 and 3 years. RESULTS: The results of ROM measurements at 3months postsurgery showed significant decreases in both flexion and abduction by 7.1 and 9.2 % and at 3 years postsurgery by 4.7 and 5.7 %. The muscle strength measurements at 3 months postsurgery showed statistically significant decreases both in adduction and in the 2nd medial rotation by 30.7 and 25.9 % and at 3 years postsurgery by 36.4 and 20.4 %. A significant improvement in these impairments was not observed for 3 years after surgery compared with that at 3 months after surgery. CONCLUSION: A combination of the LDM flap procedure and PRT could be associated with a higher incidence of tissue adhesions in both flexion and abduction and muscle deficit both in adduction and in the 2nd medial rotation.
BACKGROUND: Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3 years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT). METHODS: Eighteen patients who underwent unilateral transfer of a pedicled LDM flap and PRT within 2 months of breast-conserving surgery were enrolled in this study. Range of motion (ROM) and muscle strength in exhaustive shoulder movements were measured before surgery, and at 3 and 6 months, and 1 and 3 years. RESULTS: The results of ROM measurements at 3months postsurgery showed significant decreases in both flexion and abduction by 7.1 and 9.2 % and at 3 years postsurgery by 4.7 and 5.7 %. The muscle strength measurements at 3 months postsurgery showed statistically significant decreases both in adduction and in the 2nd medial rotation by 30.7 and 25.9 % and at 3 years postsurgery by 36.4 and 20.4 %. A significant improvement in these impairments was not observed for 3 years after surgery compared with that at 3 months after surgery. CONCLUSION: A combination of the LDM flap procedure and PRT could be associated with a higher incidence of tissue adhesions in both flexion and abduction and muscle deficit both in adduction and in the 2nd medial rotation.
Entities:
Keywords:
Breast reconstruction; Latissimus dorsi muscle flap; Postoperative radiotherapy; Prospective assessment; Shoulder function
Authors: María Jesús Casuso-Holgado; Beatriz Ostos-Díaz; María Jesús Muñoz-Fernández Journal: Int J Environ Res Public Health Date: 2022-04-04 Impact factor: 3.390