Functional sequelae following bilateral latissimus dorsi flap harvest for breast reconstruction

ABSTRACT Background: Functional arm sequelae following harvest of a unilateral Latissimus Dorsi (LD) flap are a controversial issue. Bilateral LD harvesting after mastectomy is considered a potentially disabling procedure. To clarify this point we evaluated arm and shoulder disability in an homogeneous group of patients undergoing bilateral mastectomy and LD flap reconstruction. Methods: A retrospective review of thirty bilateral mastectomies and immediate reconstruction with denervated LD flaps, performed between 2005 and 2009, was undertaken at the Plastic Surgery Unit of the Faculty of Medicine and Psychology of “Sapienza” University of Rome, Italy. No patient suffered co morbidity or previous shoulder illness. Arm disability was investigated by conducting the Disability of Arm, Shoulder and Hand (DASH) test, at a mean 23 months (range 12 - 51) from operation. Disability scores ranged from 1-100 percent, and 1-25% was regarded as mild dysfunction, 26-50% as moderate dysfunction, 51-75% as severe dysfunction and 76-100% as total dysfunction. Statistical analysis was performed with Fisher exact test and the linear regression model for variables. Results: Mean Global Dash score was 14.8 percent %. Twenty-four patients presented a mild functional deficit (< 25 percent%) while six moderate a one (< 50 percent %). Five of them presented a score < 40 percent %, only 1 patient a score of 49.1 percent %. Higher scores were significantly associated (p < 0.001) with major postoperative complications, while lower ones with re-innervated LD flaps (p <0.01). Conclusion: Results showed a mild functional impairment in the majority of patients, while a moderate to severe deficit in the group with complications. Greater impairment is observed in the heavy activities. The DASH test is a useful tool to inform patients how mastectomy and LD harvesting can affect every day life.