Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques
Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques
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DOI：
10.1016/j.bjps.2009.08.017
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发表时间：
2010-09-01
影响因子：
2.7
通讯作者：
Hart, A. M.
中科院分区：
文献类型：
--
作者：
Button, J.;Scott, J.;Hart, A. M.
背阔肌切除和腋窝手术会影响肩功能。自体背阔肌瓣（ALD）乳房再造术及供区缝合术的效果研究尚不充分。一组ALD皮瓣乳房重建术患者在术前和术后8个时间点（重建术后最长3年）使用自我管理的手臂、肩部和手部残疾（DASH）结果测量进行评估，该结果测量得到了有效的规范数据。排除偶发肩部疾病和双侧重建的患者。这是一项前瞻性、观察性研究，采用盲法数据解释：对58例患者进行了评估，其中22例进行了供体部位缝合。两组在人口统计学上、乳腺护理管理和术前DASH评分均一致（叠叠6.5分，未叠叠6.4分；P = 0.98）。术后首次临床复查时评分均显著升高（平均49分，SD19分，P < 0.001），术后6周（29分，SD20分，P < 0.001），术后3个月（19分，SD19分，P < 0.01），此后保持平台值，与15分相近（P < 0.05）。棉絮组血清肿发生率降低（5% vs 70%）。3个月DASH评分与长期功能有较强的显著相关性（r = 0.66, P < 0.0003）；DASH bbb20的患者长期表现较差（平均增加20点，SD5.0, P < 0.001）。较高的术后DASH评分与术前DASH （r = 0.58）、BMI （r = 0.36）相关。辅助治疗对肩关节功能无影响。腋窝清扫与术后3个月的DASH评分有较弱的相关性（r = 0.32, P = 0.03）。ALD皮瓣乳房重建通常导致长期DASH评分的功能不显著增加（6.5分），尽管一小部分患者确实出现长期损害，并且缝合似乎不会抑制肩部功能。(C) 2009年英国整形、重建和美容外科医师协会。Elsevier Ltd.出版。版权所有。
Latissimus dorsi harvest and axillary surgery can affect shoulder function. The effect of autologous latissimus dorsi flap (ALD) breast reconstruction and donor site quilting have been inadequately studied.A cohort of ALD flap breast reconstruction patients were assessed pre-operatively and at eight post-operative time-points (up to 3 years after reconstruction) using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, for which validated normative data is available. Patients with incidental shoulder conditions and bilateral reconstructions were excluded.This was a prospective, observational study with blinded data interpretation: 58 patients, 22 of whom had donor site quilting, were assessed. Groups were compatible demographically, in breast care management and in pre-operative DASH score (quilted 6.5, non-quilted 6.4; P = 0.98). Scores were significantly increased at initial post-operative clinic review (mean 49, SD19; P < 0.001), 6 week (29, SD20; P < 0.001), and 3 month (19, SD19; P < 0.01), thereafter remaining at a plateau value of similar to 15 (P > 0.05). Seroma incidence was reduced in the quilted group (5% vs 70%). A strong, significant correlation was found between 3 month DASH score and long term function (r = 0.66, P < 0.0003); patients with DASH > 20 fare significantly worse in the long-term (mean 20 point increase, SD5.0, P < 0.001). Higher post-operative DASH scores correlated significantly with pre-operative DASH (r = 0.58) and BMI (r = 0.36). Adjuvant therapy had no effect on shoulder function. Axillary dissection had a weak correlation with a higher DASH score, but only at the 3-month post-operative time-point (r = 0.32, P = 0.03).ALD flap breast reconstruction generally results in a functionally insignificant increase (6.5 points) in longterm DASH score, although a small subset of patients do develop longterm impairment, and quilting does not appear to inhibit shoulder function. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.