Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy

摘要

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).MethodsEighteen 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.ResultsThe 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.ConclusionA 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.