title: Objective improvement in upper limb lymphoedema following ipsilateral latissimus dorsi pedicled flap breast reconstruction--a case series and review of literature.
abstract: OBJECTIVE
  We present a series of three patients whose upper limb lymphoedema (following total oncologic mastectomy and level III axillary clearance) resolved significantly after ipsilateral pedicled latissimus dorsi (LD) flap breast reconstruction.
  
  
  METHODS
  A retrospective review of the medical records of patients who had undergone oncologic mastectomy and level III axillary clearance with subsequent LD pedicled flap reconstruction was carried out. Individuals who had undergone review and treatment by the lymphoedema service were identified and patients with incomplete pre- or post-operative records were excluded. A minimum follow-up period of 2 years of conservative therapy, as well as 2 years post-operatively was undertaken.
  
  
  RESULTS
  The rate of improvement of lymphoedema following conservative therapy was, on average, 0.095 mL/week and reached a plateau at 2-year follow-up. Following latissimus dorsi flap breast reconstruction, the rate of improvement in lymphoedema increased in all three cases, with an average improvement of 2.55 mL/week and remained sustained in the follow-up period.
  
  
  CONCLUSIONS
  Pedicled myocutaneous flap reconstruction of the ipsilateral breast proved to be a useful treatment for upper limb lymphoedema in our series. This adds an important dimension to the assessment and treatment of patients with upper limb oedema resulting from mastectomy and axillary clearance.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust, Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK. adilaku@hotmail.com
authors.forename: Muhammad Adil
authors.initials: MA
authors.lastname: Abbas Khan
authors.forename: Arvind
authors.initials: A
authors.lastname: Mohan
authors.forename: Joseph
authors.initials: J
authors.lastname: Hardwicke
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Srinivasan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Billingham
authors.forename: Christopher
authors.initials: C
authors.lastname: Taylor
authors.forename: Daniel
authors.initials: D
authors.lastname: Prinsloo
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D013524:Surgical Flaps; D035441:Thoracic Wall / Q000601:surgery*; D034941:Upper Extremity