Shoulder function after latissimus dorsi transfer in breast reconstruction
Article first published online: 14 JUL 2010
© 2010 The Authors. Clinical Physiology and Functional Imaging © 2010 Scandinavian Society of Clinical Physiology and Nuclear Medicine
Clinical Physiology and Functional Imaging
Volume 30, Issue 6, pages 406–412, November 2010
How to Cite
Forthomme, B., Heymans, O., Jacquemin, D., Klinkenberg, S., Hoffmann, S., Grandjean, F. X., Crielaard, J. M. and Croisier, J. L. (2010), Shoulder function after latissimus dorsi transfer in breast reconstruction. Clinical Physiology and Functional Imaging, 30: 406–412. doi: 10.1111/j.1475-097X.2010.00956.x
- Issue published online: 14 JUL 2010
- Article first published online: 14 JUL 2010
- Accepted for publicationReceived 18 February 2010;accepted 8 June 2010
- isokinetic assessment;
- latissimus dorsi transfer;
- muscle strength;
Background/Aims: Latissimus dorsi (LD) transfer in the case of breast reconstruction remains frequently used because this muscle provides a good size source of tissue in reconstructive surgery. Given that, the consequences of the LD removal on shoulder function and the actual loss of maximal strength developed must be investigated.
Methods: Twenty women (50 ± 7·5 years old) were evaluated before surgery, 3 and 6 months after an unilateral transfer of a pedicle flap of LD muscle used for breast reconstruction. Women performed a bilateral shoulder isokinetic assessment [for the internal rotators (IRs) and external rotators and for the abductor and adductor (ADD) muscles] allowing the establishment of bilateral muscular deficit status and the study of agonist/antagonist muscle ratios. The algofunctional and clinical status of the shoulders was analysed by the means of Constant score and specific shoulder clinical tests. The women did not perform any specific strengthening of muscle shoulder after surgery.
Results: The isokinetic assessment showed a muscle weakness 3 and 6 months after LD transfer, mainly on the ADDs (33 ± 9% at 6 months) and on the IRs (16 ± 11% at 6 months). The Constant score significantly decreased after surgery on the operated shoulder. Women with a Constant score impairment showed pain during specific shoulder clinical tests. We also found a correlation between Constant score impairment and internal rotators weakness or rotator muscle imbalance.
Conclusion: Given those results, we could advocate a specific shoulder strengthening after LD transfer, focused mainly on the IRs and ADDs.