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Hansson E, Larsson C, Uusimäki A, Svensson K, Widmark Jensen E, Paganini A. A systematic review of randomised controlled trials in breast reconstruction. J Plast Surg Hand Surg 2024; 59:53-64. [PMID: 38751090 DOI: 10.2340/jphs.v59.40087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND For preference sensitive treatments, such as breast reconstructions, there are barriers to conducting randomised controlled trials (RCTs). The primary aims of this systematic review were to investigate what type of research questions are explored by RCTs in breast reconstruction, where have they been performed and where have they been published, and to thematise the research questions and thus create an overview of the state of the research field. METHODS Randomised controlled trials investigating any aspect of breast reconstructions were included. The PubMed database was searched with a pre-defined search string. Inclusion and data abstraction was performed in a pre-defined standardised fashion. For the purpose of this study, we defined key issues as comparison of categories of breast reconstruction and comparison of immediate and delayed breast reconstruction, when the thematisation was done. RESULTS A total of 419 abstracts were retrieved from the search. Of the 419, 310 were excluded as they were not RCTs concerning some aspect of breast reconstruction, which left us with 110 abstracts to be included in the study. The research questions of the included studies could more or less be divided into seven different themes inclusive of 2 key issues: Other issues - comparison of different categories of breast reconstruction, comparison of immediate and delayed breast reconstruction, surgical details within a category of breast reconstruction, surgical details valid for several categories of breast reconstruction, donor site management, anaesthetics, and non-surgical details. Only five studies compared key issues, and they all illustrate the challenges with RCTs in breast reconstruction. CONCLUSIONS A total of 110 publications based on RCTs in breast reconstruction have been published. Seven themes of research questions could be identified. Only five studies have explored the key issues. Better scientific evidence is needed for the key issues in breast reconstruction, for example by implementing a new study design in the field.
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Affiliation(s)
- Emma Hansson
- Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden.
| | - Camilla Larsson
- The Breast Cancer Association Johanna, Gothenburg. Regional branch of the patient organisation the Swedish Breast Cancer Association
| | - Alexandra Uusimäki
- The Breast Cancer Association Johanna, Gothenburg. Regional branch of the patient organisation the Swedish Breast Cancer Association
| | - Karolina Svensson
- The Breast Cancer Association Johanna, Gothenburg. Regional branch of the patient organisation the Swedish Breast Cancer Association
| | - Emmelie Widmark Jensen
- Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden; Department of Diagnostics, Acute and Critical Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Banys-Paluchowski M, Brus L, Krawczyk N, Kopperschmidt SV, Gasparri ML, Bündgen N, Rody A, Hanker L, Hemptenmacher F, Paluchowski P. Latissimus dorsi flap for breast reconstruction: a large single-institution evaluation of surgical outcome and complications. Arch Gynecol Obstet 2024; 309:269-280. [PMID: 37584773 PMCID: PMC10770241 DOI: 10.1007/s00404-023-07186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE The use of autologous tissues is considered gold standard for patients undergoing breast reconstruction and is the preferred method in the post-radiation setting. Although the latissimus dorsi flap (LDF) has been replaced by abdominal flaps as technique of choice, it remains a valuable option in several specific clinical situations and its use has been regaining popularity in recent years. In this work, we present an 18-year retrospective analysis of a single-institution single-surgeon experience with LDF-based reconstruction with focus on early complications and reconstructive failures. METHODS Hospital records of all patients undergoing breast surgery for any reason in the Certified Breast Cancer Center, Regio Klinikum Pinneberg, Germany between April, 1st 2005 and October, 31st 2022 were reviewed. 142 consecutive LDF-based reconstructive procedures were identified. Detailed information was gathered on patient characteristics, treatment-related factors, and complications. RESULTS One hundred forty patients (139 female, 1 male) received 142 LDF-based surgeries. The flap was used mainly for immediate breast reconstruction with or without implant (83% of patients), followed by defect coverage after removal of a large tumor (7%), implant-to-flap conversion with or without placement of a new implant (6%), and delayed post-mastectomy reconstruction (4%). The use of LDF decreased between 2005 and 2020 (2005: 17, 2006: 13, 2007: 14, 2008: 16, 2009: 5, 2010: 9, 2011: 8, 2012: 3, 2013: 10, 2014: 8, 2015: 8, 2016: 7, 2017: 7, 2018: 4, 2019: 4, 2020: 2, 2021: 6, 2022: 4). Surgery was performed for invasive breast cancer in 78%, ductal carcinoma in situ in 20% and other reasons such as genetic mutation in 1% of patients. Ipsilateral radiation therapy was received by 12% of patients prior to LDF surgery and by 37% after the surgery. 25% of patients were smokers. The median duration of surgery, including all procedures conducted simultaneously such as e.g., mastectomy, axillary surgery, or implant placement, was 117 min (range 56-205). Patients stayed in the hospital for a median of 7 days (range 2-23 days). The most common complication was seroma (26%), followed by wound dehiscence (8%), surgical site infection (7%), partial skin and/or nipple necrosis of any size (7%) and hematoma requiring surgical evacuation (2%). 19% of all patients required seroma aspiration or drainage, mostly at the donor site and performed under ultrasound guidance in the ambulatory setting. Flap loss due to necrosis occurred in 2% of patients. CONCLUSIONS Latissimus dorsi flap is a well-established surgical technique commonly used for immediate breast reconstruction as well as defect coverage in locally advanced breast cancer. To the best of our knowledge, this is one of the largest single-surgeon analyses of early complications in patients receiving LDF. As expected, seroma was the most common complication observed in nearly one third of patients and requiring a therapeutic intervention in every fifth patient. Serious adverse events occurred rarely, and flap loss rate was very low.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany.
| | - Laura Brus
- Department of Gynecology and Obstetrics and Breast Cancer Center, Regio Klinikum Pinneberg, Pinneberg, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, University of Düsseldorf, Düsseldorf, Germany
| | | | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Nana Bündgen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Franziska Hemptenmacher
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter Paluchowski
- Department of Gynecology and Obstetrics and Breast Cancer Center, Regio Klinikum Pinneberg, Pinneberg, Germany
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3
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Hammond DC. Commentary on: Robot-Assisted Latissimus Dorsi Flap Harvest in Partial Breast Reconstruction: Comparison With Endoscopic and Conventional Approaches. Aesthet Surg J 2023; 44:47-49. [PMID: 37862608 DOI: 10.1093/asj/sjad306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
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4
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Kim PJ, Hircock C, Huynh MNQ, Gallo L, Thoma A. The appropriateness and quality of patient-reported outcome measures (PROMs) in plastic surgery randomized controlled trials: A systematic review. J Plast Reconstr Aesthet Surg 2023; 85:72-85. [PMID: 37473643 DOI: 10.1016/j.bjps.2023.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) quantify patient perspectives to measure outcomes that matter to patients. The aim of this study was to assess the reporting of appropriateness and quality of PROM selection in plastic surgery randomized controlled trials (RCTs). METHODS MEDLINE, Embase, and CENTRAL were searched from January 1, 2000, to June 5, 2022, to identify published RCTs within the plastic surgery literature. Included studies were categorized as follows: 1) a clearly defined patient-reported primary outcome; 2) a primary outcome could be inferred; or 3) no clear or implied primary outcome. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) database was consulted to assess the available literature on the PROMs. RESULTS There were 130 plastic surgery RCTs identified. Of the 43 studies with a clear or inferred primary outcome, the percentage of studies that commented with supporting references on the PROM's appropriateness for the population, disease/condition, and outcome were 20.9% (n = 9/43), 18.6% (n = 8/43), and 27.9% (n = 12/43), respectively. The percentage of studies that commented on the PROM's validity, reliability, and responsiveness with supporting references were 34.9% (n = 15/43), 14.0% (n = 6/43), and 11.7% (n = 5/43), respectively. There were 21 unique PROMs identified; 28.6% (n = 6/21) were available in the COSMIN database. CONCLUSION The majority of plastic surgery RCTs assessing patient-reported primary outcomes lack transparency surrounding PROM selection and quality. We recommend investigators conducting plastic surgery clinical research report explicitly why they used a particular PROM and support its appropriateness and psychometric properties with supporting references. Finally, they should familiarize themselves with the COSMIN initiative.
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Affiliation(s)
- Patrick J Kim
- McMaster University, Department of Surgery, Division of Plastic Surgery, Hamilton, Ontario, Canada
| | - Caroline Hircock
- McMaster University, Department of Medicine, Hamilton, Ontario, Canada
| | - Minh N Q Huynh
- McMaster University, Department of Surgery, Division of Plastic Surgery, Hamilton, Ontario, Canada
| | - Lucas Gallo
- McMaster University, Department of Surgery, Division of Plastic Surgery, Hamilton, Ontario, Canada
| | - Achilles Thoma
- McMaster University, Department of Surgery, Division of Plastic Surgery, Hamilton, Ontario, Canada; McMaster University, Department of Health Research Methods, Evidence and Impact (HEI), Hamilton, Ontario, Canada.
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“Wing-Shaped Skin Component of Latissimus Dorsi Myocutaneous Flap Design for Breast Reconstruction—Useful Innovation”. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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6
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Demiri EC, Tsimponis A, Pagkalos A, Georgiadou E, Goula OC, Spyropoulou GA, Dionyssiou D. Fat-Augmented Latissimus Dorsi versus Deep Inferior Epigastric Perforator Flap: Comparative Study in Delayed Autologous Breast Reconstruction. J Reconstr Microsurg 2020; 37:208-215. [PMID: 32892331 DOI: 10.1055/s-0040-1716348] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The use of autologous tissues is considered the mainstay for delayed breast reconstruction. Aside the free abdominal flaps, which are most commonly used, the fat-augmented latissimus-dorsi (FALD) flap has been recently shown a reliable alternative option for pure autologous breast reconstruction. In this retrospective study, we aim to compare outcomes of autologous breast reconstructions using the extended FALD and deep inferior epigastric perforator flap (DIEP) flap, with an emphasis on patients' characteristics, demographic data, complications, and patients' satisfaction after a minimum 12-month follow-up. METHODS Our series consists of 135 women who underwent a delayed postmastectomy unilateral autologous breast reconstruction from 2011 to 2017: 36 patients (Group A) had an extended FALD flap and 99 (Group B) a free DIEP flap performed by the same surgeons. Demographic data, breast volume, medical history, smoking, complications, and patients' satisfaction were recorded and analyzed. Student's t-test for independent variables, Mann-Whitney U-test, and Chi-squared test were used to compare the reported variables. RESULTS Patients' age, body mass index (BMI), and pregnancy history were statistically different between groups (p < 0.001, p = 0.004, p < 0.001, respectively); younger age (35.1 vs. 41.2 years), lower BMI (25.6 vs. 28.4), and fewer pregnancies were recorded in Group A. Breast volume was also found significantly smaller in Group A patients (p = 0.009). Past medical history using the ASA physical status classification score, previous radiation therapy, history of smoking, and incidence of overall complications were similar in both groups. Overall satisfaction scores were found slightly higher, but not statistically significant, in the free-flap group (p = 0.442). CONCLUSION The use of the FALD flap may provide comparable outcome to the DIEP flap in delayed breast reconstruction in terms of complications and patients' satisfaction; it should be considered a good reconstructive option for young and thin nulliparous patients, with small to medium size opposite breast.
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Affiliation(s)
- Efterpi C Demiri
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Antonios Tsimponis
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Anastasios Pagkalos
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Eleni Georgiadou
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Olga-Christina Goula
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Georgia-Alexandra Spyropoulou
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Dimitrios Dionyssiou
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
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Abstract
PURPOSE Latissimus dorsi (LD) breast reconstruction is of proven efficacy. Advantages of thoracodorsal nerve transection are potential prevention of muscle spasticity/movement; disadvantages are possible long-term muscle atrophy and volume loss. This study's purpose is to provide data that would support or refute nerve transection. METHODS A retrospective study of all LD breast reconstruction patients from 2011 to 2017 was done. Total number of flaps was identified, as was thoracodorsal nerve transection. Outcomes were noted for symptomatic muscle spasticity/involuntary movement, and complications inclusive of hematoma, seroma, and capsular contracture. RESULTS A total of 125 patients had 170 flaps. Eighty-one flaps had nerve transection; 89 did not. These cohorts had no differences in comorbidities, indications of surgery (cancer vs prophylactic), irradiation, delayed/immediate reconstruction, and use of expanders. Symptomatic muscle movement/spasticity was not significantly different: 3 (3.7%) of 78 in transection and 5 (5.6%) of 84 in nontransection (P = 0.55, χ). Incidence of seroma in the transection group was notably higher (18/81; 22% vs 12%) but not statistically significant (P = 0.09, χ). No differences existed in all other outcomes. CONCLUSIONS Symptomatic spasticity or involuntary muscle movement occurs in a small number of patients with LD breast reconstruction and is not affected by thoracodorsal nerve transection. Movement after transection is likely due to aberrant nerve innervation and reinnervation. The absence of movement without transection is due to disruption of muscle position and origin after transfer. Seroma formation may be affected by increased axillary dissection required for nerve transection. These data do not support nerve transection, and therefore, it is not recommended.
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Yilmaz KB, Saydam M, Tokgoz S, Akinci M, Balas S, Azili C, Karabacak H, Akkoca M. A novel monitorization technique for nerve protection during axillary surgery of the breast cancer patients. Breast J 2019; 26:809-811. [PMID: 31564058 DOI: 10.1111/tbj.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Kerim Bora Yilmaz
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Mehmet Saydam
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Serhat Tokgoz
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Melih Akinci
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Sener Balas
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Cem Azili
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Harun Karabacak
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Muzaffer Akkoca
- Department of General Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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Senger JL, Wolfli J. Late animation deformity in the denervated pedicled latissimus dorsi flap. Breast J 2019; 26:685-690. [PMID: 31448462 DOI: 10.1111/tbj.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/01/2022]
Abstract
Optimal management of the thoracodorsal nerve in pedicled latissimus dorsi flaps for mastectomy reconstruction is controversial. The incidence and etiology of animation deformity despite muscle denervation remain poorly- understood. This study examines the incidence, etiology, and risk factors of late animation. A retrospective review identified breasts reconstructed with a denervated pedicled latissimus dorsi flap. The incidence and severity of postoperative animation were examined with investigation of potential patient, oncologic, and reconstructive causative factors. Patients completed a survey to assess lifestyle implications. A cadaveric dissection identified anatomical causes of persistent muscle innervation. Forty-one reconstructions with a minimum follow-up of 2 years (average 6.25 years) identified no significant relationship between animation and patient or treatment factors. While absent in the first postoperative year, animation was identified in 90% of patients on long-term follow-up, with 32% reporting pain, and 25% indicating lifestyle interferences. This high frequency of animation correlated with cadaveric results that identified multiple extramuscular nerve branches innervating the latissimus in 9 of 10 specimens. The distance between nerve branches was 5.4 ± 0.7 mm, and the distance between the superior muscle margin and the branching point was 22.7 ± 2.3 mm. Persistent animation deformity, despite nerve transection, is attributable to anatomical differences in the thoracodorsal branching patterns, rather than patient or therapeutic factors. While early follow-up may suggest transection of a single nerve branch is adequate to prevent animation, our study demonstrates that long term, it is insufficient in most cases. Exploration for additional nerve branches or high division proximal to the branching site is suggested, and preoperative patient counseling is recommended.
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Affiliation(s)
- Jenna-Lynn Senger
- Division of Plastic & Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - James Wolfli
- Division of Plastic & Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada
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10
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Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery. Plast Reconstr Surg 2018; 142:947e-957e. [DOI: 10.1097/prs.0000000000005040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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11
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Neurological complications of systemic tumor therapy. Wien Med Wochenschr 2018; 169:33-40. [PMID: 30232660 DOI: 10.1007/s10354-018-0654-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
The treatment of malignant tumors has considerably improved in recent years, and also the number of "long term cancer survivors" is increasing.The spectrum of anti-tumoral agents is increasing at a fast pace and in addition to conventional therapies such as surgery, radiotherapy, and chemotherapy, new drugs with entirely new mechanisms are appearing. Side effects of old and new drugs can affect the central and peripheral nervous system, the neuromuscular junction, and muscle. These side effects often have to be distinguished from other causes and need neurological expertise. Although the majority of patients still receive conventional therapies, several new strategies such as immune therapies are being implemented. These drugs have also drug specific side effects, which do not always follow the classical principles of "toxicity."This review focuses on the well-known and described side effects of conventional cancer therapies and adds new observations on new drugs.
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Blackburn NE, Mc Veigh JG, Mc Caughan E, Wilson IM. The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review. Eur J Cancer Care (Engl) 2017; 27:e12664. [PMID: 28185324 DOI: 10.1111/ecc.12664] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 11/30/2022]
Abstract
Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 to 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate post-operative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.
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Grisold W, Grisold A, Löscher WN. Neuromuscular complications in cancer. J Neurol Sci 2016; 367:184-202. [PMID: 27423586 DOI: 10.1016/j.jns.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/08/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - W N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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14
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Bilateral Thoracodorsal Neuromas: A Cause of Persistent Breast Pain after Bilateral Latissimus Dorsi Breast Reconstruction. Arch Plast Surg 2015. [PMID: 26217577 PMCID: PMC4513065 DOI: 10.5999/aps.2015.42.4.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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15
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Hwang MJ, Sterne G. Thoracodorsal nerve division in latissimus dorsi breast reconstruction to avoid unwanted breast animation: a safe and simple technique to ensure division of all branches. J Plast Reconstr Aesthet Surg 2014; 68:e43-4. [PMID: 25456287 DOI: 10.1016/j.bjps.2014.09.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Mei-Ju Hwang
- Department of Plastic Surgery, Birmingham City Hospital, Dudley Road, Birmingham B18 7QH, UK.
| | - Guy Sterne
- Department of Plastic Surgery, Birmingham City Hospital, Dudley Road, Birmingham B18 7QH, UK
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