The Effect of Mini-Latissimus Dorsi Flap (MLDF) Reconstruction on Shoulder Function in Breast Cancer Patients (original) (raw)
Related papers
PRRS, 2024
Background. The Fat-Augmented LD (FALD) flap is a workhorse flap for autologous breast reconstruction (BR). Latissimus Dorsi muscle is responsible for upper limb medial rotation, adduction and extension and contributes to the glenohumeral joint stabilization. To date, controversial conclusions have been reached about shoulder impairment following BR with FALD flap. Methods. The study prospectively enrolled 36 patients (46 flaps) who underwent BR with FALD flap. Participants underwent a shoulder ultrasound imaging, analysing the acromio-humeral interval (AHI) measurement pre-operatively (t 0 ), at 6 (t 1 ) and 12 (t 2 ) months after surgery and completed the DASH questionnaire. Teres major thickness was determined with dorsal ultrasound, preoperatively and at least 12 months after surgery. Statistical analysis using linear mixed effects model was performed with significant values < 0.05. Results. Comparing the mean AHI value of each follow-up time (t1 and t2) to the mean AHI value at the baseline (t0) the pattern remained quite the same, with a non-significant reduction between t0-t1 (p = 0.873) and a little increase between t0-t2 (p = 0.468). Self-reported outcomes showed a similar trend with a reduction in upper limb function initially compared to pre-operative status (t 0 ), followed by an improvement at the subsequent intervals (all p < 0.05). Dorsal US showed an increase in TM thickness postoperatively compared to preoperative values (11.4 vs 12.4 mm; p = 0.01984). Conclusions. BR with FALD flap is a safe procedure since no long-term shoulder disability was found according to AHI, dorsal US, and DASH questionnaire assessments.
Measurement of objective shoulder function following breast cancer surgery: a scoping review
Physical Therapy Reviews, 2020
Background: Decreased shoulder function is frequently experienced by breast cancer survivors following surgery, and it is associated with both decreased ability to perform daily living tasks and decreased overall quality of life, even several years post-surgery. Shoulder function is often measured with self-reported questionnaires. If objective measurements are taken, they are frequently restricted to range of motion measurement in the cardinal planes of movement. It is not known to what extent shoulder motion in more functional tasks has been investigated. Objectives: This review aims to determine what is known about the objectively evaluated shoulder function following breast cancer and to determine what are the most frequently used methods for evaluation. Methods: This protocol outlines the steps that will be taken to conduct a high quality scoping review on the objective measurement of shoulder function in breast cancer survivors. A comprehensive search of several databases will be performed to identify all relevant research. All identified studies will be screened and those including the objective measurement of shoulder function of breast cancer survivors post-surgery will be included. Data will be extracted by two reviewers and results will be consolidated and presented in narrative form as well as tables and figures. Conclusion: The resulting synthesis of the literature will provide a comprehensive overview of the current methods of evaluating shoulder function in breast cancer survivors. This review will elucidate gaps in knowledge regarding objective measurement of shoulder function and help to develop future research questions.
Physical Therapy Reviews, 2017
Background: Decreased shoulder function is frequently experienced by breast cancer survivors following surgery, and it is associated with both decreased ability to perform daily living tasks and decreased overall quality of life, even several years post-surgery. Shoulder function is often measured with self-reported questionnaires. If objective measurements are taken, they are frequently restricted to range of motion measurement in the cardinal planes of movement. It is not known to what extent shoulder motion in more functional tasks has been investigated. Objectives: This review aims to determine what is known about the objectively evaluated shoulder function following breast cancer and to determine what are the most frequently used methods for evaluation. Methods: This protocol outlines the steps that will be taken to conduct a high quality scoping review on the objective measurement of shoulder function in breast cancer survivors. A comprehensive search of several databases will be performed to identify all relevant research. All identified studies will be screened and those including the objective measurement of shoulder function of breast cancer survivors post-surgery will be included. Data will be extracted by two reviewers and results will be consolidated and presented in narrative form as well as tables and figures. Conclusion: The resulting synthesis of the literature will provide a comprehensive overview of the current methods of evaluating shoulder function in breast cancer survivors. This review will elucidate gaps in knowledge regarding objective measurement of shoulder function and help to develop future research questions.
Gland Surgery, 2021
Background: The latissimus dorsi (LD) flap is used in cases of immediate breast reconstruction after total or partial mastectomy. However, studies on the effect of unilateral LD flap reconstruction on skeletal posture and comparison with results from mastectomy-only have been sparse. Thus in this prospective, observational study, we compared skeletal posture and functional recovery in patients who underwent a mastectomy-only versus those who underwent breast reconstruction with a LD flap after mastectomy. Methods: From January 2018 to February 2020, a total of 54 patients were enrolled. The control group included 23 patients who underwent mastectomy-only and the experimental group included 31 patients who underwent breast reconstruction using a LD flap immediately after mastectomy. We assessed the Cobb's angle in spine X-rays, parameters derived from photometry, computed tomography (CT), and 3D scanning preoperatively (T0), 6 months post-surgery (T1), and 1-year post-surgery (T2). We also evaluated functional outcomes, such as pain intensity, disability of the upper extremities, and quality of life. Results: In the control and experimental groups, the average age was 58.7/46.2 years, body mass index (BMI) was 24.9/22.5, and excised mass weight was 386.8/259.1 g, respectively. In the control group, differences in the Cobb's angle were significant between T0 and T2 (P=0.003). There were significant differences in the Cobb's angle and time interaction effects between the two groups (P=0.015). The degree of change in the Cobb's angle between T0 and T1 was positively correlated with change in the vertical distance from the 3D scanner midline to the nipple (P=0.009). Conclusions: The experimental group showed improved recovery in skeletal posture compared to the control group. Further, discovering the parameters that can predict the change of skeletal posture through a 3D scanner will have clinical significance. Accordingly, performing breast reconstruction by unilaterally applying the LD muscle is a safe, reliable, and useful method of autologous tissue transfer for breast cancer patients.
Supportive Care in Cancer, 2018
Objective: Determine the changes in shoulder strength, shoulder range of motion and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Method: 68 SLNB and 44 ALND patients were followed-up from pre-surgery to 5 years after surgery. Primary outcomes were the differences between affected and non-affected sides for: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry and lymphedema measured by volume. As a secondary outcome, health related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. GEE models were constructed to assess the effect of SLNB and ALND over time. Results: After 5 years, the ALND group had significant loss of strength for internal rotators (1.39 kg, p=0.001) and significant arm volume increase (132.45 mL, p=0.031). The ALND group had a greater number of patients with clinically relevant internal rotators strength loss (38.7% vs. 13.6%, p=0.012) and a greater number of lymphedema requiring treatment (33.3% vs. 3.4%, p<0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in Physical and Arm domains persisted at 5 years in both SLNB and ALND groups. Conclusion: These results could help understand and plan the prevention, needs, and long term care of breast cancer patients.
Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy
Acta Oncologica, 2012
Background. A recent study in our laboratory found signifi cant differences in scapular kinematics between the affected and unaffected sides of women reporting shoulder pain following treatment for breast cancer. An earlier smaller study from our laboratory found reduced muscle activity from four key muscles and an association with greater shoulder pain and disability. The aims of this study were to: correlate altered muscle activity from a larger sample with observed movement deviations; compare within subject movement and muscle deviations in survivors with healthy variation; explore the impact of a mastectomy vs. a wide local excision (WLE) on the observed deviations. Method. Cross-sectional study. One hundred and fi fty-fi ve women treated for unilateral carcinoma of the breast and 21 age-matched healthy women were included in the study. All patients fi lled out the Shoulder Pain and Disability Index (SPADI). Three-dimensional (3D)-kinematic data and EMG muscle activity were recorded during scaption on the affected and unaffected side. The association between kinematic data, EMG data, SPADI and covariates was determined using a two stage, random effects mixed multiple regression technique. Results. All scapula kinematic and muscle EMG parameters in both arms were altered in breast cancer survivors when compared to healthy participants. Altered movement patterns were different for left vs. right side affected. Mastectomy patients demonstrated greater movement deviations and reported signifi cantly higher levels of pain than WLE patients. Conclusion. Shoulder morbidity is bilateral, greater in patients having a mastectomy and is present for up to six years post-surgery. This study and others now provide ample evidence to support prospective surveillance programmes that can be integrated into Survivorship Programmes.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
It has been shown that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction. It is controversial how big an impact the flap innervation has on the muscle activity of the flap. The aim of the study was to prospectively evaluate the influence of latissimus dorsi flap innervation on the functional and aesthetic outcome of delayed breast reconstruction. Between 2007 and 2008, 28 breast reconstructions were performed and randomly divided into denervation group (surgical denervation by excision of 1 cm of proximal thoracodorsal nerve, n=14) and innervation group (thoracodorsal nerve saved intact, n=14). Patients were clinically evaluated and a questionnaire considering functional and aesthetic outcome was filled 1-year after operation. Muscular twitching, pain, tightness, shape and symmetry of the breasts were evaluated. In addition, the mobility of the shoulder joint on the operated side was evaluated and the patients self-estimated the activities of daily living. There was no significant difference in latissimus dorsi flap twitching, pain and tightness of the breast and symmetry and shape of the breasts between denervated and innervated groups. The shoulder joint mobility was not found to be changed significantly in either of the groups and there were no limitations in activities of daily living. Thoracodorsal nerve division or preservation does not significantly affect muscle contraction activity of the latissimus dorsi flap and distortion of the breast when latissimus dorsi muscle humeral insertion is also detached. Therefore, both cutting and saving the nerve are justified in latissimus dorsi flap breast reconstruction depending on whether the humeral insertion of the muscle is preserved intact or divided and the flap islanded. The study shows that there is no tangible benefit in dividing the nerve when the flap is islanded. Clinical trial has been registered in public trials registry. Trial registry name is &amp;amp;amp;amp;#39;The significance of latissimus dorsi flap innervation in delayed breast reconstruction&amp;amp;amp;amp;#39;. Registration number is NCT01239524 and URL is https://register.clinicaltrials.gov.
Effects of Breast Cancer Treatment on Shoulder Function: What to Expect and How to Treat?
International Journal of Physical Therapy & Rehabilitation, 2018
Breast cancer treatment may lead to side effects such as shoulder pain, restricted shoulder mobility, fibrosis, breast cancer-related lymphedema, and anatomical and biomechanical changes of the shoulder, which will contribute to functional status limitations. Function of the upper limb requires adequate mobility of the shoulder, including the scapula, and an efficient neuromuscular coordination. Movement deviation patterns in women following surgery for breast cancer are similar to those seen in other known shoulder conditions. Exercise therapy and scapular stabilization exercises were found to be an effective approach for controlling pain, promote normal motor control and decreasing disability. The main purpose of the present paper is to review the shoulder movement dysfunctions after breast cancer treatment and to briefly characterize the main physical therapy intervention strategies to treat or prevent these dysfunctions.