title: Immediate breast reconstruction with a Latissimus dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery.
abstract: BACKGROUND
  Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy.
  
  
  METHODS
  This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up.
  
  
  RESULTS
  There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group.
  
  
  CONCLUSIONS
  The authors' study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion.
  
  
  METHODS
  Therapeutic, II.
authors: Campinas, São Paulo, Brazil From the Department of Obstetrics and Gynecology, State University of Campinas, Faculty of Medical Sciences.
authors: Riza Rute
authors: RR
authors: de Oliveira
authors: Simony Lira
authors: SL
authors: do Nascimento
authors: Sophie F M
authors: SFM
authors: Derchain
authors: Luís Otávio
authors: LO
authors: Sarian
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000502:physiology*; D013997:Time Factors; D000267:Tissue Adhesions / Q000503:physiopathology / Q000517:prevention & control
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