Shoulder-related donor site morbidity after delayed breast reconstruction with pedicled flaps from the back:An open label randomized controlled clinical trial

Autor: Jens Ahm Sørensen, Mikkel Børsen Rindom, René dePont Christensen, Marianne D. Lautrup, Tina Tos, Lisbet Rosenkrantz Hölmich, Jørn Bo Thomsen, Gudjon Leifur Gunnarsson
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Mammaplasty/adverse effects
Mammaplasty
030230 surgery
Surgical Flaps
law.invention
0302 clinical medicine
Postoperative Complications
Randomized controlled trial
law
Activities of Daily Living
Superficial Back Muscles/transplantation
Clinical endpoint
Breast reconstruction
Range of Motion
Articular
Patient-reported outcome
Chronic pain
Breast Neoplasms/physiopathology
Thoracodorsal artery perforator flap
Shoulder function
030220 oncology & carcinogenesis
Axillary Artery/transplantation
Surgical Flaps/adverse effects
Postoperative Complications/etiology
Female
Range of motion
Range of Motion
Articular/physiology
medicine.medical_specialty
Latissimus dorsi flap
Breast Neoplasms
Transplant Donor Site
03 medical and health sciences
Shoulder Pain
medicine.artery
medicine
Humans
Muscle Strength
Patient Reported Outcome Measures
Thoracodorsal artery
business.industry
Constant shoulder score
Pedicled Flap
medicine.disease
Surgery
Superficial Back Muscles
Muscle Strength/physiology
Shoulder Pain/etiology
Axillary Artery
business
Follow-Up Studies
Zdroj: Rindom, M B, Gunnarsson, G L, Lautrup, M D, Christensen, R D, Tos, T, Hölmich, L R, Sørensen, J A & Thomsen, J B 2019, ' Shoulder-related donor site morbidity after delayed breast reconstruction with pedicled flaps from the back : An open label randomized controlled clinical trial ', Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 72, no. 12, pp. 1942-1949 . https://doi.org/10.1016/j.bjps.2019.07.027
Rindom, M B, Gunnarsson, G L, Lautrup, M D, Christensen, R D, Tos, T, Hölmich, L R, Sørensen, J A & Thomsen, J B 2019, ' Shoulder-related donor site morbidity after delayed breast reconstruction with pedicled flaps from the back : An open label randomized controlled clinical trial ', Journal of Plastic, Reconstructive & Aesthetic Surgery (Online), vol. 72, no. 12, pp. 1942-1949 . https://doi.org/10.1016/j.bjps.2019.07.027
DOI: 10.1016/j.bjps.2019.07.027
Popis: BACKGROUND: This randomized controlled trial (RCT) investigates differences in shoulder-related morbidity after delayed breast reconstruction by either a latissimus dorsi (LD) flap or a thoracodorsal artery perforater (TAP) flap.MATERIAL AND METHODS: In accordance with the CONSORT guidelines, we included women for unilateral delayed breast reconstruction. Patients were randomized to reconstruction by either of the two flaps. Shoulder-function was assessed at baseline and at 3, 6 and 12 months after surgery. The primary endpoint was patient-reported shoulder-related pain. A further objective assessment by the Constant Shoulder Score (CSS) was included as secondary endpoints.RESULTS: A total of 50 women were enrolled over a two-year period and allocated to reconstruction, with 25 patients in each group. Patient-reported shoulder-related pain was significantly lower in the TAP group at 12 months after surgery when adjusting for pain at baseline: OR = 0.05 95%CI(0.005-0.51), p-value = 0.011. The estimated effect on the total CSS at 12 months, when applying the TAP flap instead of the LD flap and adjusting for the baseline score, was 6.2 points with 95%CI(0.5-12.0), p-value 0.033. The TAP flap seems to have a statistically significant positive effect on pain and activity in daily life (ADL), while there were no significant effect on range of motion and strength after one year.CONCLUSION: Patient reconstructed by the TAP flap are less likely to experience shoulder-related pain and have a better shoulder-function one year after the reconstruction. Harvest of the LD flap carries a higher risk of shoulder-function impairment, chronic pain and reduced ADL.
Databáze: OpenAIRE
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