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PubMed1997

The clavipectoral osteomyocutaneous free flap.

Microvascular free tissue transfer has revolutionized head and neck reconstruction and currently is considered the most successful and reliable method of primary oromandibular reconstruction. This study was designed to assess the feasibility of full thickness free vascularized transfer of the clavicle based on the clavicular branch of the thoracoacromial artery and the soft tissue component associated with the thoracoacromial axis. Forty dissections of the pectoral region were performed on 26 cadavers. The anatomic relations of the region and the thoracoacromial arterial and venous systems were documented in detail. Selective ink injections of the thoracoacromial arterial branches were also performed on fresh cadavers. The clavicle was supplied mainly by the clavicular artery (medial three quarters), with minor contribution from the deltoid artery (lateral quarter). An average of 16.1 cm (range of 12 to 20 cm) was obtained with total clavicular harvest and the clavicle had sufficient width and height to support dental implants. Two soft tissue donor sites were associated with the thoracoacromial artery: the sternocostal head of the pectoralis major muscle, with the overlying skin supplied by the pectoral artery, and the clavicular head of the pectoralis major muscle, with the overlying skin supplied by the deltoid and clavicular arteries. Sensory innervation of the upper chest was supplied through the supraclavicular nerves, whereas the lateral pectoral nerve supplied motor innervation to both heads of the pectoralis major muscle. The anatomy of the clavipectoral donor site and the first case of full thickness free clavicular transfer for mandibular reconstruction in the English literature are presented. The donor site is an excellent source of well vascularized, thin, pliable, hairless, potentially innervated (motor and sensory) soft tissue, along with up to 20 cm of clavicular bone. The surgical anatomy is familiar to the head and neck surgeon. The harvesting does not require repositioning of the patient and is amenable to a two-team, simultaneous approach. The functional and cosmetic donor site morbidity is minimal even with clavicular harvest. The major disadvantage of this flap is the relatively short pedicle. The authors conclude that the thoracoacromial system provides a free flap with osseous and soft tissue components that are well suited for oromandibular reconstruction.

Acromion↗
PubMed1997

Operative treatment of irreparable rupture of the subscapularis.

Between 1980 and 1994, 221 shoulders with recurrent anterior glenohumeral subluxation or dislocation were reconstructed at our institution. At the time of the operation, thirteen shoulders were found to have an irreparable injury of the subscapularis muscle, which we believed to be a contributing factor to the ongoing instability. All but three of the thirteen patients had had two to six previous reconstructions. Operative treatment of the irreparable rupture included a dynamic muscle transfer using the pectoralis major in seven shoulders, the pectoralis minor in five, and both of these muscles in one. According to a modification of the grading system of Neer and Foster, the result was satisfactory for ten shoulders and unsatisfactory for three at a mean of five years after the operation. All shoulders with a satisfactory result demonstrated active contraction of the transferred pectoralis muscle and diminished anterior glenohumeral translation. On the basis of our analysis, we concluded that transfer of the pectoralis muscle is effective for reconstruction of the shoulder in patients who have loss of the subscapularis muscle.

Adult↗
PubMed2002

Developmental expression of skeletal muscle heparan sulfate proteoglycans in turkeys with different growth rates.

Heparan sulfate proteoglycans (HSPG) are a group of extracellular matrix molecules that link skeletal muscle cells to their extrinsic environment. To investigate if HSPG expression is affected by muscle growth and gender, a turkey line (F) selected for increased 16-wk BW and its unselected random-bred control line, RBC2, were used in the present study. Heparan sulfate (HS) and HSPG levels were measured in embryonic and posthatch pectoralis major muscle. HS levels plateaued at embryonic day (ED) 16 in both lines. A significant decrease of HS occurred at ED 18 in F males and females, and at ED 20 and 22 in the RBC2 males and females, respectively. Embryonic HSPG levels peaked at ED 18, and were significantly higher from ED 14 through 18 in F males and females compared with those of the RBC2 line. Male pectoralis major muscle had more HSPG at early embryonic stages than female muscle in both lines. During 1 to 16 wk posthatch, F male and female pectoralis major muscle contained more HSPG than the RBC2 samples, and HSPG levels in F males were higher than those of the females. Myogenic satellite cells derived from F and RBC2 male and female pectoralis major muscle were cultured to measure HSPG expression during proliferation and differentiation. No significant difference in HSPG level was found between the RBC2 and F line cells. However, in both lines, male-derived satellite cells had more HSPG than the female cells during proliferation and differentiation. These data show that HS and HSPG expression are affected by muscle growth properties and sex.

Age Factors↗
PubMed1978

Chimaera studies of the origin and formation of the pectoral musculature of the avian embryo.

Cervical, brachial, and thoracic somites and brachial somatopleure were transplanted from quail into 2-day chick embryos to determine their contribution to the formation of the pectoralis major muscle. The results show that the musculature of the pectoralis major and pectoralis minor is derived entirely from brachial somites (16-20) while the brachial somatopleure provides much of the connective tissue of these muscles. Migration of somitic cells into the somatopleure appears to begin before the somites are fully formed. The primordium of the pectoralis muscle forms at the base of the wing bud and extends ventro-caudally into the thoracic area to attach to the sternum.

Animals↗
PubMed1997

In vitro characteristics of myogenic satellite cells derived from the pectoralis major and biceps femoris muscles of the chicken.

Satellite cells were isolated from the pectoralis major (PM) and biceps femoris (BF) muscles of 5-week-old broiler chickens to compare growth and differentiation characteristics in vitro. BF cells proliferated at greater rates in the growth medium and were more responsive to the mitogenic effects of chicken serum than PM cells at all levels tested (p < or = 0.05). When low serum-containing medium was administered, the levels of creatine kinase, a marker of differentiation, increased at greater rates in PM cultures than in BF cultures (p < or = 0.05). Administration of increasing levels of fibroblast growth factor in serum-free medium resulted in similar responsiveness of the two lines to this mitogen. No differences were detected in rates of protein synthesis or degradation in myotube cultures from the two muscle sources. The results suggest that satellite cells derived from PM and BF muscles of the chicken have different responsiveness to serum mitogens.

Animals↗
PubMed1996

An axillary arch.

An axillary (axillopectoral) muscle (arch) was observed extending between the upper border of the latissimus dorsi and the lower border of the pectoralis major muscles in a 48-year-old male cadaver during our dissections. In the same cadaver, the pectoralis major muscle has entirely inserted into the most distal part of the tendon of deltoideus.

Axilla↗
PubMed2006

The segmental pectoralis major free flap: anatomical features of its vascular pedicle.

BACKGROUND: The pectoralis major muscle may be suited for free transplantation of a segment of the muscle. We investigated the length and diameter of its vascular pedicle to determine its feasibility. METHODS: The length of the pedicle, its arterial diameter, and its entry point into the muscle were determined in 17 cadaveric flaps. RESULTS: The pedicle length up to the medial border of the pectoralis minor muscle averaged 6.6 cm. The mean external arterial diameter was 1.8 mm, and the venous diameter was consistently larger. The vascular pedicle consistently entered the muscle lateral to the midpoint of, and a mean of, 8.8 cm caudal to the clavicular line. CONCLUSION: The vascular length and diameter are sufficient for microvascular anastomosis. Although an anatomic landmark for the cranial border of the flap could not be defined, the sternocostal part of the pectoralis major muscle may potentially be used as a segmental free flap.

Anastomosis, Surgical↗
PubMed2005

[Sonoanatomy of the muscles and fascia spaces of the pectoral regions].

BACKGROUND: Aim of the study was to work out a reliable method for the ultrasonographic evaluation of the pectoral region. METHODS: The study was performed in 20 cadaver specimens and 20 healthy volunteers as well as in 10 patients with disorders of the pectoral region. RESULTS: For examination of the pectoralis major muscle, the landmark for the positioning of the ultrasound transducer was found to be the lateral border of the anterior axillary fold in the direction of the tip of the coracoid process. Tilting the probe medially, the fibres of the pectoralis major muscle become visible in longitudinal alignment. The main part of the clavicular portion of the pectoralis major muscle can be visualised by moving the probe parallel to this position. Tilting the probe downwards, both the internal part of the clavicular portion, the sterno-costal and the abdominal portion are evaluated. For examination of the pectoralis minor muscle, the probe is positioned between the tip of the coracoid process and the sternal angle. Thus the whole muscle can be examined with a single sweep of the transducer. In all the specimens, probands and patients of our group, both muscle, fascias and pathological lesions could be clearly depicted. SUMMARY: Based on the introduction of standard examination planes, the pectoral region can be evaluated in detail using ultrasonography. Lesions and pathologic changes can be reliably appointed to individual anatomical structures.

Fascia↗
PubMed2004

Unilateral occurrence of a chondroepitrochlearis muscle.

An abnormal muscle slip was encountered during routine dissection studies of a male cadaver. According to its origin, attachment and innervation, the abnormal slip was identified a chondroepitrochlearis muscle. Arterial and nervous supply were from the lateral thoracic artery and the medial pectoral nerve, respectively. Furthermore, no axillary arch muscle was observed. In addition, an abnormality in the attachment of the pectoralis major muscle was observed.

Adult↗
PubMed1989

Fate of skin element of pectoralis major flap in intraoral reconstruction.

A skin island carried by pectoralis major muscle has been used to reconstruct an intraoral defect created after resection of a tumor. To our knowledge, what happens to the skin after its mobilization from the chest wall into the mouth has not been documented. To answer this, a wedge biopsy of the intraoral skin island on the pectoralis muscle was performed in 14 patients under local anesthesia. The skin biopsy specimen was subjected to scanning electron microscopic and histologic examination. The interval between the reconstructive surgery and the biopsy ranged from ten to 66 months (mean, 32 months). The results revealed desquamation of the epidermis and loss of appendages. The degree of desquamation was maximal when the skin island was used to replace the whole of the floor of the mouth and least when it was used for the lateral portion.

Adult↗
PubMedDate not supplied

Transpectoral anterior approach to the axilla for lymph node dissection in association with mastectomy preserving both pectoral muscles and their neurovascular bundles.

In Patey's mastectomy, which is still the most common operation for breast cancer, axillary node dissection (AND) is performed through the base of the axilla after retracting the pectoralis major muscle and excising the pectoralis minor muscle (some surgeons preserve the latter). This has the disadvantage of inadequate exposure of the axilla and the risk of damage to the neurovascular bundles supplying the pectoral muscles, which in the long run may lead to atrophy of these muscles. A transpectoral anterior approach to the axilla for AND in association with mastectomy was attempted in 115 cases to obviate the above-mentioned disadvantages. The approach included: 1) splitting of the pectoralis major between the clavicular and sternal fibers; 2) mobilization and swinging of the pectoralis minor into different directions by means of a sling to facilitate AND at selected levels. The major advantages of this approach were: 1) total preservation of both pectoral muscles with their neurovascular bundles maintained the normal anatomy and function of the shoulder; 2) the axilla was directly approached through the anterior wall instead of through the base; in this way the axillary contents were exposed almost at surface level; 3) the dissection plane could be limited to anterior to and below the axillary vein and the risk of postoperative lymphedema could thus be minimized; 4) change of position of the ipsilateral arm was not necessary; 5) the duration of surgery was reduced. Monoblock ablation of significant and suspected tissues, maintaining the normal anatomy and function of the shoulder, could be easily accomplished with this approach.

Adult↗
PubMed1987

Salvage of upper arm access grafts by extension to the infraclavicular axillary vein.

A technique has been described to salvage upper arm graft fistulas using expanded polytetrafluoroethylene grafts by subcutaneous extension to the infraclavicular axillary vein. The axillary vein is exposed through an infraclavicular incision near the lateral end of the clavicle by splitting the pectoralis major muscle and by dividing or retracting the pectoralis minor muscle medially. A new segment of polytetrafluoroethylene graft is anastomosed to the axillary vein, and then to the old graft segment. This technique was employed in six patients over a 12 month period, with a 24 month graft patency rate of 84 percent. The advantage over a new access graft is immediate hemodialysis through a puncture of the preserved arterial limb of the polytetrafluoroethylene graft.

Arteriovenous Shunt, Surgical↗
PubMed2004

Operative treatment of postpulmonectomy empyema.

OBJECTIVE: To analyse retrospectively 10 patients with postpulmonectomy empyema. METHODS: Ten patients (9 men, 1 woman, aged 48 to 69 years) with postpulmonectomy empyema treated over a 12 year period (1991--2002) were analysed. Nine of the patients had pulmonectomy for lung carcinoma and one--for pulmonary abscess. All postpulmonectomy empyemas were managed in two stages--an open-window thoracostomy for curing the infective process in the empyema cavity and then closure of the bronchopleural fistulas and obliteration of the cavity. Video-assisted thoracoscopy (VATS) was successfully used by the authors for sterilization and debridement of the cavity, and finally to insert two thoracic drains for the cavity lavage. The obliteration of the empyema cavity was achieved by a vascular muscle flap transposition from the thoracic muscles. The latissimus dorsi muscle flap was used in 6 patients. The pectoralis major muscle flap was used in 4 patients. Additionally, a thoracoplasty was performed in the patients with pectoralis major muscle flap transposition. RESULTS: Eight patients (80%) were discharged from hospital without complications, and two patients died (20%). CONCLUSIONS: On the basis of the study results and the literature review the authors conclude that the applied therapy yields good results in the treatment of postpulmonectomy empyema.

Aged↗
PubMed2004

A novel technique of raising a pectoralis major myocutaneous flap through the skin paddle incision alone.

A good reconstruction should not only be functionally and aesthetically sound at the recipient site but also cause least possible cosmetic aberration of the donor site. The pectoralis major myocutaneous (PMMC) flap continues to be one of the most commonly used flap for head and neck reconstruction in this part of the world. Conventionally, once the skin paddle over the pectoralis major muscle is marked, a line is drawn joining the outer edge of the skin flap extending to the apex of the anterior axillary skin fold or midclavicular point to expose the underlying pectoralis major muscle and harvest the flap. We intend to suggest a novel technique, in which the pectoralis major muscle is exposed by raising the skin around the skin paddle incision alone without making any further extension.

Dermatologic Surgical Procedures↗
PubMed1989

Pectoralis major defect and Poland sequence in second cousins: extension of the Poland sequence spectrum.

We report on a patient with congenital absence of the left pectoralis major muscle, whose second cousin had the full Poland sequence. This suggests that isolated pectoralis major muscle defect should be included in the spectrum of anomalies characterized as the Poland sequence, postulated to result from disruption of blood supply in the embryonic subclavian and vertebral arteries, the site and degree of obstruction determining the sites and severity of the resulting anomalies. Very few cases are familial; in these the family pattern is compatible with an autosomal dominant mutant gene with reduced penetrance or delayed mutation.

Humans↗
PubMed1964

INTRACELLULAR DISTRIBUTION OF CALCIUM IN DEVELOPING BREAST MUSCLE OF NORMAL AND DYSTROPHIC CHICKENS.

To follow the intracellular distribution of calcium in the breast muscles of developing chickens, Ca(45) was injected into the albumen of predeveloped eggs. Since the embryos were grown in a radioactive medium, a complete exchange of the isotope for its non-radioactive counterpart in muscles was accomplished. Subcellular particulates of the muscle cells were separated by the method of differential centrifugation. Analysis of the separated fractions showed that in the muscles of the 13-day embryo, when the nuclear-myofibrillar ratio is high, 65 per cent of the muscle calcium is in the nuclei. With the increased synthesis of myofibrils, the nuclear-myofibrillar ratio decreases with a concomitant fall in radioactivity. Thus, calcium was not associated with the developing myofibrils. At the time of hatching, when myofibrils perform physiological work, the highest level of calcium is in the mitochondria. This suggests that the mitochondria play a key role in the physiological activities of calcium in the cell. The microsomal fraction reaches a maximal level of calcium when the adult composition of muscle is attained. Results of investigations on dystrophic muscles show changes in the calcium distribution of the fractions as early as the 3rd week of embryonic development, which are interpreted to indicate an alteration in the protein metabolism of the cell, or an early destruction of muscle tissue. Further, alterations in the calcium content of fractions which seem to regulate the movements of this ion in the cell are discussed. A new technique for homogenizing tissues from embryos of different ages is presented.

Animals↗