title: Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy.
abstract: BACKGROUND
  Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3 years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT).
  
  
  METHODS
  Eighteen patients who underwent unilateral transfer of a pedicled LDM flap and PRT within 2 months of breast-conserving surgery were enrolled in this study. Range of motion (ROM) and muscle strength in exhaustive shoulder movements were measured before surgery, and at 3 and 6 months, and 1 and 3 years.
  
  
  RESULTS
  The results of ROM measurements at 3months postsurgery showed significant decreases in both flexion and abduction by 7.1 and 9.2 % and at 3 years postsurgery by 4.7 and 5.7 %. The muscle strength measurements at 3 months postsurgery showed statistically significant decreases both in adduction and in the 2nd medial rotation by 30.7 and 25.9 % and at 3 years postsurgery by 36.4 and 20.4 %. A significant improvement in these impairments was not observed for 3 years after surgery compared with that at 3 months after surgery.
  
  
  CONCLUSIONS
  A combination of the LDM flap procedure and PRT could be associated with a higher incidence of tissue adhesions in both flexion and abduction and muscle deficit both in adduction and in the 2nd medial rotation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan. sowawan@kpu-m.ac.jp.
authors.forename: Yoshihiro
authors.identifier: http://orcid.org/0000-0002-7112-1630
authors.initials: Y
authors.lastname: Sowa
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.|Department of Rehabilitation, University Hospital, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Morihara
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.|Department of Rehabilitation, University Hospital, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Kushida
authors.affiliation: Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sakaguchi
authors.affiliation: Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Taguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Numajiri
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D053580:Muscle Strength; D011182:Postoperative Care; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012782:Shoulder / Q000502:physiology*; D064171:Superficial Back Muscles / Q000601:surgery; D013524:Surgical Flaps
keywords: Breast reconstruction; Latissimus dorsi muscle flap; Postoperative radiotherapy; Prospective assessment; Shoulder function