Functional impairment after latissimus dorsi flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Musculoskeletal Function

Background:

• Latissimus myocutaneous flap reconstruction is common for breast and chest wall defects.
• Previous reports indicated minimal functional impairment after latissimus dorsi muscle sacrifice.
• Clinical observations suggested otherwise, necessitating further investigation into functional deficits.

Purpose of the Study:

• To evaluate the functional deficit in patients who underwent latissimus dorsi muscle reconstruction.
• To assess the impact of latissimus dorsi muscle loss on arm and shoulder function.

Main Methods:

• Retrospective review of patients from 1998-2003 at St Vincent's Hospital.
• Patient recruitment via telephone contact.
• Functional assessment using the Disability of Arm, Shoulder and Hand (DASH) questionnaire.

Main Results:

• Six of 18 surveyed patients reported moderate functional deficits (DASH score ≥ 30), limiting housework.
• High DASH scores correlated with major postoperative complications (P=0.028).
• Bilateral flap patients and athletes experienced significant functional impairment in daily activities and sports.

Conclusions:

• Patients require thorough counseling on potential functional sequelae after latissimus dorsi flap surgery.
• Athletes and those undergoing bilateral procedures face higher risks of reduced performance.
• Preserving the latissimus dorsi muscle with alternative flaps (e.g., perforator cutaneous flaps) should be considered.