Seoul, Republic of Korea From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Plast Reconstr Surg. 2014 Aug;134(2):303-314. doi: 10.1097/PRS.0000000000000365.
The authors performed a comprehensive literature review regarding functional impairment after latissimus dorsi muscle transfer, to investigate functional changes in the donor site and the potential impact on patients' daily lives.
The PubMed database was searched for articles regarding functional donor-site morbidity following latissimus dorsi muscle flap harvest. Articles discussing the thoracodorsal artery perforator flap, which shares the same donor sites with the latissimus dorsi muscle flap, were also included. Functional morbidity was analyzed based on questionnaire of subjective symptoms, Disabilities of the Arm, Shoulder and Hand questionnaire, shoulder range of motion, and shoulder strength.
Twenty-two articles representing 719 cases in 644 patients were reviewed, including seven prospective and 15 retrospective cohort studies. As a questionnaire summary from eight articles, 94 of 232 patients (41 percent) experienced any kind of discomfort at the donor site. In the Disabilities of the Arm, Shoulder and Hand questionnaire from seven articles, little difficulty in daily activities but significant difficulties in sports and art activities were observed. Nine of 13 articles reported some limitations of shoulder motion, particularly during the early postoperative period, and four other articles detected little limitation. Eight of 12 articles reported some shoulder strength weakness over time, and shoulder extension, adduction, and internal rotation were commonly involved. The muscle-sparing latissimus dorsi and thoracodorsal artery perforator flaps showed low functional morbidity.
Functional impairment of the shoulder could develop after latissimus dorsi muscle flap transfer. Knowledge of the flap's functional morbidity will allow surgeons to inform patients regarding donor-site expectations and to accomplish better surgical outcomes.
作者对 Latissimus dorsi 肌转移后功能障碍进行了全面的文献回顾，旨在研究供区的功能变化及其对患者日常生活的潜在影响。
在 PubMed 数据库中检索关于 Latissimus dorsi 肌皮瓣采集后供区功能发病率的文章。还包括讨论胸背动脉穿支皮瓣的文章，该皮瓣与 Latissimus dorsi 肌皮瓣具有相同的供区。根据主观症状问卷、上肢功能障碍问卷、肩关节活动范围和肩部力量分析功能发病率。
回顾了 644 例患者 719 例的 22 篇文章，包括 7 项前瞻性和 15 项回顾性队列研究。8 篇文章的问卷综述显示，232 例患者中有 94 例（41%）在供区有任何不适。7 篇文章的上肢功能障碍问卷显示，日常生活活动稍有困难，但运动和艺术活动困难明显。9 篇文章报道了一些肩关节运动受限，尤其是在术后早期，另外 4 篇文章检测到轻微的限制。12 篇文章中的 8 篇报道了随着时间的推移肩部力量的减弱，并且经常涉及肩伸肌、内收肌和内旋肌。保留肌肉的 Latissimus dorsi 和胸背动脉穿支皮瓣显示出较低的功能发病率。
Latissimus dorsi 肌皮瓣转移后可能会出现肩部功能障碍。了解皮瓣的功能发病率将使外科医生能够向患者告知供区的预期，并取得更好的手术效果。
