title: Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques.
abstract: 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.
authors.affiliation: Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. Jane.Button@ggc.scot.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Button
authors.forename: J
authors.initials: J
authors.lastname: Scott
authors.forename: R
authors.initials: R
authors.lastname: Taghizadeh
authors.forename: E
authors.initials: E
authors.lastname: Weiler-Mithoff
authors.forename: A M
authors.initials: AM
authors.lastname: Hart
mesh_terms: D000704:Analysis of Variance; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery* / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D049291:Seroma / Q000453:epidemiology; D012782:Shoulder / Q000503:physiopathology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome