title: A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer.
abstract: BACKGROUND
  The authors performed a comprehensive literature review regarding functional impairment after latissimus dorsi muscle transfer, to investigate functional changes in the donor site and the potential impact on patients' daily lives.
  
  
  METHODS
  The PubMed database was searched for articles regarding functional donor-site morbidity following latissimus dorsi muscle flap harvest. Articles discussing the thoracodorsal artery perforator flap, which shares the same donor sites with the latissimus dorsi muscle flap, were also included. Functional morbidity was analyzed based on questionnaire of subjective symptoms, Disabilities of the Arm, Shoulder and Hand questionnaire, shoulder range of motion, and shoulder strength.
  
  
  RESULTS
  Twenty-two articles representing 719 cases in 644 patients were reviewed, including seven prospective and 15 retrospective cohort studies. As a questionnaire summary from eight articles, 94 of 232 patients (41 percent) experienced any kind of discomfort at the donor site. In the Disabilities of the Arm, Shoulder and Hand questionnaire from seven articles, little difficulty in daily activities but significant difficulties in sports and art activities were observed. Nine of 13 articles reported some limitations of shoulder motion, particularly during the early postoperative period, and four other articles detected little limitation. Eight of 12 articles reported some shoulder strength weakness over time, and shoulder extension, adduction, and internal rotation were commonly involved. The muscle-sparing latissimus dorsi and thoracodorsal artery perforator flaps showed low functional morbidity.
  
  
  CONCLUSIONS
  Functional impairment of the shoulder could develop after latissimus dorsi muscle flap transfer. Knowledge of the flap's functional morbidity will allow surgeons to inform patients regarding donor-site expectations and to accomplish better surgical outcomes.
authors.affiliation: Seoul, Republic of Korea From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Kyeong-Tae
authors.initials: KT
authors.lastname: Lee
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
mesh_terms: D006801:Humans; D009140:Musculoskeletal Diseases / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D019651:Plastic Surgery Procedures; D012782:Shoulder / Q000503:physiopathology*; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps / Q000637:transplantation*
references.citation: Maxwell GP. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg. 1980;65:686–692
references.citation: Laitung JK, Peck F. Shoulder function following the loss of the latissimus dorsi muscle. Br J Plast Surg. 1985;38:375–379
references.citation: Russell RC, Pribaz J, Zook EG, Leighton WD, Eriksson E, Smith CJ. Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg. 1986;78:336–344
references.citation: Fraulin FO, Louie G, Zorrilla L, Tilley W. Functional evaluation of the shoulder following latissimus dorsi muscle transfer. Ann Plast Surg. 1995;35:349–355
references.citation: Spear SL, Hess CL. A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles. Plast Reconstr Surg. 2005;115:2070–2073
references.citation: Brumback RJ, McBride MS, Ortolani NC. Functional evaluation of the shoulder after transfer of the vascularized latissimus dorsi muscle. J Bone Joint Surg Am. 1992;74:377–382
references.citation: Glassey N, Perks GB, McCulley SJ. A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction. Plast Reconstr Surg. 2008;122:1334–1340
references.citation: Forthomme B, Heymans O, Jacquemin D, et al. Shoulder function after latissimus dorsi transfer in breast reconstruction. Clin Physiol Funct Imaging. 2010;30:406–412
references.citation: Giordano S, Kääriäinen K, Alavaikko J, Kaistila T, Kuokkanen H. Latissimus dorsi free flap harvesting may affect the shoulder joint in long run. Scand J Surg. 2011;100:202–207
references.citation: Salmi A, Tuominen R, Tukiainen E, Asko-Seljavaara S. Morbidity of donor and recipient sites after free flap surgery: A prospective study. Scand J Plast Reconstr Surg Hand Surg. 1995;29:337–341
references.citation: Clough KB, Louis-Sylvestre C, Fitoussi A, Couturaud B, Nos C. Donor site sequelae after autologous breast reconstruction with an extended latissimus dorsi flap. Plast Reconstr Surg. 2002;109:1904–1911
references.citation: Adams WP Jr, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg. 2004;53:6–11
references.citation: Tarantino I, Banic A, Fischer T. Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg. 2006;117:1387–1394
references.citation: Koh CE, Morrison WA. Functional impairment after latissimus dorsi flap. ANZ J Surg. 2009;79:42–47
references.citation: Saint-Cyr M, Nagarkar P, Schaverien M, Dauwe P, Wong C, Rohrich RJ. The pedicled descending branch muscle-sparing latissimus dorsi flap for breast reconstruction. Plast Reconstr Surg. 2009;123:13–24
references.citation: Brackley PT, Mishra A, Sigaroudina M, Iqbal A. Modified muscle sparing latissimus dorsi with implant for total breast reconstruction: Extending the boundaries. J Plast Reconstr Aesthet Surg. 2010;63:1495–1502
references.citation: Button J, Scott J, Taghizadeh R, Weiler-Mithoff E, Hart AM. Shoulder function following autologous latissimus dorsi breast reconstruction: A prospective three year observational study comparing quilting and non-quilting donor site techniques. J Plast Reconstr Aesthet Surg. 2010;63:1505–1512
references.citation: de Oliveira RR, Pinto e Silva MP, Gurgel MS, Pastori-Filho L, Sarian LO. Immediate breast reconstruction with transverse latissimus dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy. Ann Plast Surg. 2010;64:402–408
references.citation: Losken A, Nicholas CS, Pinell XA, Carlson GW. Outcomes evaluation following bilateral breast reconstruction using latissimus dorsi myocutaneous flaps. Ann Plast Surg. 2010;65:17–22
references.citation: de Oliveira RR, do Nascimento SL, Derchain SF, Sarian LO. Immediate breast reconstruction with a latissimus dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery. Plast Reconstr Surg. 2013;131:673e–680e
references.citation: Kim H, Wiraatmadja ES, Lim SY, et al. Comparison of morbidity of donor site following pedicled muscle-sparing latissimus dorsi flap versus extended latissimus dorsi flap breast reconstruction. J Plast Reconstr Aesthet Surg. 2013;66:640–646
references.citation: Paolini G, Amoroso M, Pugliese P, Longo B, Santanelli F. Functional sequelae following bilateral mastectomy and immediate reconstruction with latissimus dorsi flap: Medium-term follow-up. J Plast Surg Hand Surg. 2013;48:99–103
references.citation: Izadi D, Paget JT, Haj-Basheer M, Khan UM. Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconstr Aesthet Surg. 2012;65:1357–1362
references.citation: Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–146
references.citation: Bot SD, Terwee CB, van der Windt DA, Bouter LM, Dekker J, de Vet HC. Clinimetric evaluation of shoulder disability questionnaires: A systematic review of the literature. Ann Rheum Dis. 2004;63:335–341
references.citation: Gosselink R, Rouffaer L, Vanhelden P, Piot W, Troosters T, Christiaens MR. Recovery of upper limb function after axillary dissection. J Surg Oncol. 2003;83:204–211
references.citation: Shamley DR, Srinanaganathan R, Weatherall R, et al. Changes in shoulder muscle size and activity following treatment for breast cancer. Breast Cancer Res Treat. 2007;106:19–27
references.citation: Kärki A, Simonen R, Mälkiä E, Selfe J. Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. J Rehabil Med. 2005;37:180–188
references.citation: Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM. Shoulder movement after breast cancer surgery: Results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Res Treat. 2002;75:35–50
references.citation: Beurskens CH, van Uden CJ, Strobbe LJ, Oostendorp RA, Wobbes T. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer. 2007;7:166
references.citation: Lauridsen MC, Christiansen P, Hessov I. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: A randomized study. Acta Oncol. 2005;44:449–457
references.citation: Adriaenssens N, Vinh-Hung V, Miedema G, et al. Early contralateral shoulder-arm morbidity in breast cancer patients enrolled in a randomized trial of post-surgery radiation therapy. Breast Cancer (Auckl.). 2012;6:79–93