A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction.
BACKGROUND
The impact on shoulder function from removal of the latissimus dorsi muscle in breast reconstruction is important because of the common nature of this operation. Informed consent requires us to discuss the impact of surgery and likely recovery times. The literature already supports the absence of long-term effects from this procedure. However, all studies and subsequent reviews are based on retrospective studies, thus making it impossible to assess recovery time scales compared with preoperative values. In this prospective study, the authors set out to define the impact on shoulder function and, importantly, to assess recovery time scales compared with preoperative values.


METHODS
Shoulder range of motion, strength, function, and pain were assessed prospectively in 22 subjects who had latissimus dorsi muscle flap breast reconstruction. Assessments were carried out preoperatively and then at 6 weeks, 6 months, and 1 year postoperatively using standardized objective assessments.


RESULTS
The results demonstrate no significant loss of range of motion, strength, function, or pain at 1 year. However, strength, disability scores, neural glide, and discomfort were still abnormal at 6 months and then normalized at 1 year. It was noted that the extended latissimus dorsi flap tended to have poorer scores and recovery compared with a latissimus dorsi flap and implant.


CONCLUSIONS
The authors believe this information to be important to the patient, therapist, and surgeon in the assessment of postoperative recovery from this procedure.
Glassey
Nicole
N
Nottingham, United Kingdom From the Burns and Plastic Surgery Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus.
Perks
Graeme B
GB
McCulley
Stephen J
SJ
D000328:Adult; D000368:Aged; D001415:Back; D002637:Chest Pain; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000534:rehabilitation*; D008875:Middle Aged; D009017:Morbidity; D018482:Muscle, Skeletal / Q000601:surgery*; D010149:Postoperative Pain; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012785:Shoulder Joint / Q000502:physiology*