A prospective case-control study of disability, quality of life, and functional impairment of shoulder movements after latissimus dorsi myocutaneous flap reconstruction in breast cancer patients
Gitika Nanda Singh1
, Parijat Suryavanshi1, Shariq Ahmad3, Shubhajeet Roy2
1Department of General Surgery, King George’s Medical University, Lucknow, India
2 King George’s Medical University, Faculty of Medical Sciences, Lucknow, India
3Department of Surgery, Government Medical College Badaun, Badaun, India
Abstract
Objective: Dysfunction of shoulder movements could be a limiting factor to the use of Latissimus dorsi (LD) flap. This study aimed to assess the impact of LD flap reconstruction on shoulder dysfunction and the quality of life.
Material and Methods: This study comprised 28 early breast cancer cases who underwent breast conserving surgery (BCS) with LD flap and 40 controls. Subjective and objective assessments were done a year later.
Results: Mild and moderate disability were found in 85.71% and 14.3% cases vs. 100% and 0% controls (p= 0.316) respectively. Physical and emotional functioning were 84.29 ± 5.61 and 66.67 ± 6.05 in cases vs. 86.67 ± 8.38 and 70.0 ± 6.84 in controls (p= 0.36, 0.23) respectively. Pain score in cases was 23.8 ± 15.6 vs. 12.17 ± 8.4 in controls (p= 0.018). LD muscle strength in extension was 4.39 ± 0.35 in cases vs. 4.88 ± 0.22 in controls (p< 0.001), 4.43 ± 0.18 for adduction in cases vs. 4.65 ± 0.24 in controls (p= 0.006). ROM of shoulder in flexion was 151.61 ± 4.86° in cases and 153.88 ± 2.36° in controls (p= 0.08), 40.36 ± 3.52° in cases vs. 49.13 ± 1.86° in controls for extension (p< 0.001), in abduction it was 150.54 ± 3.69° in cases vs. 150.00 ± 0.00° in controls (p= 0.518), in adduction was 30.89 ± 4.0° in cases vs. 38.13 ± 1.11° in controls (p< 0.001), in external rotation was 73.57 ± 3.63° in cases vs. 77.63 ± 2.36° in controls (p< 0.001), and internal rotation was 69.46 ± 3.56° in cases vs. 79.00 ± 1.26° in controls (p< 0.001).
Conclusion: We conclude that functional impairment should not be a determining factor for LD flap in breast reconstruction surgery.
Keywords: Latissimus dorsi, flap reconstruction, quality of life, shoulder dysfunction, breast conserving surgery
Cite this article as: Singh GN, Suryavanshi P, Ahmad S, Roy S. A prospective case-control study of disability, quality of life, and functional impairment of shoulder movements after latissimus dorsi myocutaneous flap reconstruction in breast cancer patients. Turk J Surg 2024; 40 (1): 65-72.
This study was approved by the King George’s Medical University U.P. Institutional Ethics Committee (Decision no: 1728/Ethics/19, Date: 11.11.2019).
Externally peer-reviewed.
Concept - GNS, PS; Design - GNS, SA; Supervision - GNS, PS; Fundings - GNS, PS; Materials - GNS, PS; Data Collection and/or Processing - SA, SR; Analysis and/or Interpretation - SA, SR; Literature Search - SA, SR; Writing Manuscript - SR; Critical Reviews - GNS, PS.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.