title: Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity.
abstract: OBJECTIVE
  Dissection of the latissimus dorsi (LD) flap may have a distinct impact on upper extremity function and strength. To date, insufficient differentiation has been made between loss of muscular strength and shoulder function by dissection of the LD muscle per se and loss of function resulting from all excisional surgery, radiation therapy, and reconstructive procedures at the donor site and the recipient site that may have been combined near the shoulder region.
  
  
  METHODS
  This study determines the long-term effect of the LD breast reconstruction on the strength profiles of the upper extremity by measuring the isometric torque strength both in seven synergistic- and two contra-movement directions. The Biodex System 3 Pro (Biodex Medical Systems, New York, NY) was used in 12 patients at a mean of 3.5 years after surgery, and in 20 matched controls. Because loss of LD muscle may not result in significant impairment of activities of daily live (ADL) even in cases where objective measurements are decreased, this study simultaneously assessed the subjective function by use of the standardised Disability of Arm, Shoulder and Hand (DASH) questionnaire.
  
  
  RESULTS
  This study observed a significant long-term loss of 8.8 Nm or 19% LD torque strength in synergistic movement directions after transplantation of the LD muscle. This loss correlated significantly with an increase of the mean DASH score among the patients.
  
  
  CONCLUSIONS
  Because no significant loss of contra-movement torque strength was observed, it was concluded that the loss of synergistic torque strength appears to result from the loss of LD function per se.
authors.affiliation: a Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital , Amsterdam , the Netherlands ;
authors.forename: Martine A
authors.initials: MA
authors.lastname: van Huizum
authors.affiliation: a Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital , Amsterdam , the Netherlands ;
authors.forename: Marije J
authors.initials: MJ
authors.lastname: Hoornweg
authors.affiliation: b The Faculty of Movement Sciences , VU Medical Centre , Amsterdam , the Netherlands.
authors.forename: Noor
authors.initials: N
authors.lastname: de Ruiter
authors.affiliation: b The Faculty of Movement Sciences , VU Medical Centre , Amsterdam , the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Oudenhoven
authors.affiliation: a Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital , Amsterdam , the Netherlands ;
authors.forename: J Joris
authors.initials: JJ
authors.lastname: Hage
authors.affiliation: b The Faculty of Movement Sciences , VU Medical Centre , Amsterdam , the Netherlands.
authors.forename: Dirk Jan
authors.initials: DJ
authors.lastname: Veeger
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D053580:Muscle Strength; D011183:Postoperative Complications / Q000503:physiopathology; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000502:physiology / Q000503:physiopathology*
keywords: DASH score; Latissimus dorsi muscle; breast reconstruction; muscular torque strength