A Systematic Review and Meta-analysis of Functional Shoulder Impairment After Latissimus Dorsi Breast Reconstruction
| Autor: | Mia C W Steffenssen, Ann-Louise H Kristiansen, Tine Engberg Damsgaard |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty MOTION Mammaplasty shoulder and upper extremity MEDLINE Breast Neoplasms 030230 surgery FLAP Risk Assessment SEQUELAE 03 medical and health sciences 0302 clinical medicine DONOR-SITE MORBIDITY STRENGTH Shoulder function Medicine Humans breast reconstruction Range of Motion Articular Mastectomy Physical Therapy Modalities latissmus dorsi OUTCOMES business.industry Level iv Evidence-based medicine RECOVERY Prognosis Exercise Therapy Treatment Outcome Shoulder Impingement Syndrome 030220 oncology & carcinogenesis Meta-analysis Physical therapy Superficial Back Muscles Dash score Surgery Female business Breast reconstruction Range of motion human activities musculocutaneous flap |
| Zdroj: | Steffenssen, M C W, Kristiansen, A-L H & Damsgaard, T E 2019, ' A Systematic Review and Meta-analysis of Functional Shoulder Impairment After Latissimus Dorsi Breast Reconstruction ', Annals of Plastic Surgery, vol. 82, no. 1, pp. 116-127 . https://doi.org/10.1097/SAP.0000000000001691 |
| Popis: | Purpose The latissimus dorsi flap (LDF) is a very reliable flap and may be used for a multitude of reconstructive purposes. It is widely used for breast reconstruction when performed. It has few complications, except for a possible impact on shoulder function. The aims of this study were to evaluate the validity of the literature by investigating the level of evidence and to perform a meta-analysis. Methods A systematic literature search was conducted using the databases PubMed, Scopus, and Web of Science. Predictor variables were shoulder function after breast reconstruction with the LDF. Articles were chosen according to 4 different outcomes: shoulder range of motion (ROM), shoulder strength, DASH score, and subjective evaluation. Results Twenty-six articles were found, including 1045 patients: 8 level II, 16 level III, 1 level IV, and 1 level V articles. The meta-analysis showed that both ROMs for flexion and abduction are significantly impaired at less than or at 3 months of follow-up. Conclusions There are several influencing factors, such as age, smoking, obesity, radiotherapy, and physiotherapy. Moreover, the impact on shoulder function seemed influenced by the type of thoracodorsal vessel-based flap. From the level of evidence analysis, there is a tendency that the LDF transfer does affect shoulder function. This limitation seems to be minimal, and few patients experience a major impact on shoulder function. However, the existing literature on total shoulder impairment after breast reconstruction with LDF is insufficient to draw any final conclusion. There is a need for future studies and current articles that suggest that the initial measurement should be performed preoperatively (preferably at the time of diagnosis or initial biopsy) and follow-ups with measurements at 6, 12, and 24 months (long-term effect) after surgery. We recommend measurements of both operated and nonoperated sides. Each measurement should be accompanied by a history with special emphasis on shoulder function. The methods of measuring outcomes of recommendation are DASH score, ROM with use of a goniometer preferably by a physiotherapist or a health care professional trained by a physiotherapist, and strength measured by, for example, a handheld dynamometer. |
| Databáze: | OpenAIRE |
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