title: Abdominal strength after breast reconstruction using a free abdominal flap.
abstract: BACKGROUND
  Today, breast reconstruction with autologous tissue is most commonly done either as a free muscle sparring TRAM flap or as a DIEP flap. Studies of donor site morbidity have shown an advantage in using the DIEP flap. However, this procedure might also be associated with an increased risk of flow related complications and it is also thought to be more demanding and time consuming. A few studies have evaluated the abdominal wall strength after dissection of a TRAM flap or a DIEP flap. However, these studies do not distinguish between the various types of free TRAM flaps and they also compare TRAM procedures preformed in an early period to DIEP procedures done in a later period.
  
  
  METHODS
  We used an isokinetic dynamometer to measure concentric, eccentric and isometric abdominal muscle strength in 32 patients who had had a unilateral breast reconstruction with a free MS-2 (15) or a DIEP (17) flap in the year 2003.
  
  
  RESULTS
  No significant reduction in muscle strength was observed for concentric or isometric muscle strength. However, significant lower eccentric muscle strength was found in the TRAM compared to the DIEP group (p=0.05). There was no significant difference in abdominal strength between the two flap groups at low to moderate work intensity (isometric/concentric). At the greatest work intensity (eccentric muscle strength) the patients reconstructed with a DIEP flap had a clinical small, but significant advantage over the patients reconstructed with a MS-2 TRAM flap.
authors.affiliation: Department of Plastic Surgery and Burns Unit, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. bonde@rh.dk
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bonde
authors.forename: Hans
authors.initials: H
authors.lastname: Lund
authors.forename: Marie
authors.initials: M
authors.lastname: Fridberg
authors.forename: Bente
authors.initials: B
authors.lastname: Danneskiold-Samsoe
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Elberg
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D013524:Surgical Flaps; D016896:Treatment Outcome