Joo Oh Young, Moon Seung Jin, Lee Dong Won, Lew Dae Hyun, Lee Won Jai, Song Seung Yong
Department of Plastic and Reconstructive Surgery, Institute of Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2021 Nov;48(6):583-589. doi: 10.5999/aps.2021.00500. Epub 2021 Nov 15.
In prosthesis-based breast reconstruction patients, the drain tends to be kept in place longer than in patients who undergo only mastectomy. Postoperative arm exercise also increases the drainage volume. However, to preserve shoulder function, early exercise is recommended. In this study, we investigated the effect of early exercise on the total drainage volume and drain duration in these patients.
We designed a prospective randomized trial involving 56 patients who underwent immediate breast reconstruction following mastectomy using tissue expanders. In each group, the patients were randomized either to perform early arm exercises using specific shoulder movement guidelines 2 days after surgery or to restrict arm movement above the shoulder height until drain removal. The drain duration and the total amount of drainage were the primary endpoints.
There were no significant differences in age, height, weight, body mass index, or mastectomy specimen weight between the two groups. The total amount of drainage was 1,497 mL in the early exercise group and 1,336 mL in the exercise restriction group. The duration until complete removal of the drains was 19.71 days in the early exercise group and 17.11 days in the exercise restriction group.
Exercise restriction after breast reconstruction did not lead to a significant difference in the drainage volume or the average time until drain removal. Thus, early exercise is recommended for improved shoulder mobility postoperatively. More long-term studies are needed to determine the effect of early exercise on shoulder mobility in prosthesis-based breast reconstruction patients.
在接受假体植入式乳房重建的患者中，引流管留置的时间往往比仅接受乳房切除术的患者更长。术后手臂运动也会增加引流量。然而，为了保持肩部功能，建议尽早进行运动。在本研究中，我们调查了早期运动对这些患者总引流量和引流管留置时间的影响。
我们设计了一项前瞻性随机试验，纳入了56例使用组织扩张器在乳房切除术后立即进行乳房重建的患者。在每组中，患者被随机分为两组，一组在术后2天按照特定的肩部运动指南进行早期手臂运动，另一组则将手臂运动限制在肩部高度以上，直至引流管拔除。引流管留置时间和总引流量是主要终点指标。
两组患者在年龄、身高、体重、体重指数或乳房切除标本重量方面均无显著差异。早期运动组的总引流量为1497毫升，运动限制组为1336毫升。早期运动组引流管完全拔除的时间为19.71天，运动限制组为17.11天。
乳房重建后限制运动并未导致引流量或引流管拔除平均时间出现显著差异。因此，建议尽早进行运动以改善术后肩部活动度。需要更多的长期研究来确定早期运动对接受假体植入式乳房重建患者肩部活动度的影响。
