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PubMedDate not supplied

Pectoralis major ruptures postsuction lipectomy for surgical management of gynecomastia.

Over the last decade, suction-assisted lipoplasty has been shown to be a safe and reliable procedure in the hands of trained individuals. A large number of plastic surgeons employ liposuction as an adjunct to surgery for gynecomastia with excellent results and low morbidity. An unusual problem, traumatic rupture of the pectoralis major muscle, has been observed by us in a patient who had undergone the procedure. The physical deficit arising from the injury may go unnoticed in all but the most physically active people, and surgeons should be wary of the possibility of this previously unreported complication.

Adult↗
PubMed1988

Salvage of esophageal cripple with a lined pectoralis major tube flap.

A staged reconstructive procedure is described for the reconstruction of the entire thoracic esophagus. All primary alternatives for esophageal reconstruction were not applicable. The patient's thoracic esophagus was successfully reconstructed in two stages with a lined pectoralis major muscle tube, and it remains, eight months postoperatively, in good general condition without clinical or radiological evidence of any fistula, stricture, or obstruction. He enjoys an oral diet without restrictions and has gained a total of 19 pounds in the postoperative period.

Anastomosis, Surgical↗
PubMed2006

Anatomy and clinical significance of pectoral fascia.

BACKGROUND: The submuscular or subglandular plane for breast augmentation is widely used. Recently, the subfascial plane for breast augmentation was reported by some authors who achieved satisfactory results. The anatomy of the pectoral fascia in Chinese female corpses was investigated to explore the possibility for a location of augmentation mammaplasty under the pectoral fascia. METHODS: The anatomy of 30 side pectoral fascias on 15 corpses was studied. The thicknesses of the pectoral fascias were measured. RESULT: The pectoral fascia is attached to the clavicle and sternum and covers the pectoralis major muscle. It is continuous inferiorly with the fascia of the abdominal wall. Furthermore, the pectoral fascia extends laterally to be continuous with the fascia of the back. The pectoral fascia, which can be successfully dissected bluntly along the subfascial plane, varies in thickness from 0.2 to 1.14 mm. Perforating branches of vessels and nerves emerging from the pectoral fascia are located mainly at the medial lateral and lower fascias. CONCLUSIONS: The pectoral fascias can be dissected bluntly along a subfascial plane with the pectoral fascia intact. The potential pocket between the pectoralis major muscle and the pectoral fascia can be used as a place for breast augmentation. The pectoral fascia may provide the breast implant with more soft-tissue coverage.

Adult↗
PubMedDate not supplied

Liposuction to debulk the pectoralis major myocutaneous flap.

Pectoralis major myocutaneous flaps are very useful for head and neck reconstruction. However, excess bulk in these flaps due to subcutaneous fat can be a disadvantage in oral cavity, oropharyngeal, and cervical esophageal reconstruction. A variety of surgical modifications have been tried in an effort to overcome this problem. Liposuction was proposed by a member of this research group as a means to debulk such flaps. The purpose of this fresh cadaver study was to determine what effect this procedure might have on blood supply to the skin overlying the pectoralis major muscle. Gross and histologic observations suggest that liposuction would not significantly affect the vascular perfusion of these flaps. This report represents a preliminary study previous to a clinical trial using a potentially useful technique. It is hoped by the authors that this report will stimulate others to evaluate it's possible clinical utility.

Humans↗
PubMed1983

[Biologic bases of musculo-cutaneous flaps most frequently used in cervico-maxillo-facial surgery].

An anatomical investigation on the vascular supply to "Pectoralis major", "Trapezius lateralis" and "Latissimus dorsi" muscolo-cutaneous flaps is presented. The AA. call particular attention to the vascular supply of the cutis going beyond the muscular borders. In this way we can determine the maximal width of the flap it is possible to achieve, without previous autonomization and without trophic problems.

Head and Neck Neoplasms↗
PubMedDate not supplied

[Clinical and etiological data in 21 cases of Poland's syndrome].

Clinical and etiological data of 21 cases of Poland's syndrome are reported. The anomaly was seen especially on the right side and was significantly more frequent in males than in females (4:1). The variable expressivity of the morphology of the ipsilateral hand is analyzed. Height of the hand was obtained in 18 cases. Simian crease and Sydney line are significantly more frequent in patients than in controls. These observations confirmed that unilateral isolate absence of the pectoralis major muscle is a mild expression of the syndrome. Most of the cases were sporadic. No difference was found in the number of spontaneous abortions between the mothers of patients and controls. In one family, it seems that a mother-to-child transmissin was present which could be explain by an autosomal dominant inheritance.

Adolescent↗
PubMed1984

The vascular territory of the acromiothoracic axis.

The precise vascular territory and the variations of the acromio-thoracic axis were investigated in a series of 60 fresh cadavers and 50 formalin fixed specimens using dissection, ink injection and barium radiographic studies. The sternocostal portion and the clavicular head of the pectoralis major were found to have virtually independent vascular and nerve supplies. The pectoral artery supplied the former, whereas the deltoid artery nourished the latter. The dominant supply from the pectoral artery to the rib cage was found to enter around the fourth rib in the mid clavicular line. This supply is associated with a previously undescribed origin of the pectoralis major muscle in this region. The supply to the sternum was determined as indirect via the captured territory of the internal mammary system. The dominant supply to the skin from the pectoral artery arose laterally along the free lower border of the muscle as fasciocutaneous branches. The deltoid artery supplies the skin over the shoulder by numerous small branches which emerge from the intramuscular septa of the deltoid muscle. In addition a large axial artery was noted. In most cases this arose from the deltoid artery or its acromial branch and coursed laterally. It is noteworthy that the majority of skin paddles of the pectoralis major myocutaneous flap currently used in clinical practice are designed medially and inferiorly around the perimeter of the muscle and onto the rectus sheath. In these situations such flaps are not supplied directly by the pectoral artery. In fact, they are supplied indirectly by cutaneous branches belonging to the internal mammary/superior epigastric system which are captured by arterial connections with the pectoral artery. These occur predominantly in the pectoralis major muscle. Suggestions, based on these anatomical studies, are offered to improve the versatility and safety of flaps designed in this area.

Acromion↗
PubMed2004

Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization.

OBJECTIVE: To evaluate the factors related to surgical complications, rate of gastrostomy tube (G-tube) dependence, and hospitalization in patients undergoing reconstruction with a pectoralis myocutaneous flap vs a soft-tissue revascularized flap. DESIGN: Quasi-experimental case series with a historic control group. POPULATION: A total of 179 patients (138 men and 41 women) with a mean (SD) age of 58 (14) years treated between January 1, 1986, and December 31, 1995, with a pectoralis flap (108 patients) or a revascularized free flap (71 patients). METHODS: Inclusion criteria were first or second extirpation, reconstruction with soft-tissue flap, or defect including the upper aerodigestive tract. Exclusion criteria were secondary reconstruction, or reconstruction for salvage of a complication. RESULTS: Although the major complication rate was not significantly different according to reconstructive approach, hypopharyngeal defects had a significantly higher major complication rate of 30% (6/20) compared with 8% (13/159) for other defect sites (P<.003). The minor complication rate was higher in the pectoralis group, at 57% (62/108), than in the revascularized flap group, at 21% (15/71) (P<.001). G-tube dependence was higher in the pectoralis group at 42% (40/96), in contrast to the revascularized flap group at 16% (10/63) (P<.001). G-tube dependence was 25% higher in patients who underwent salvage surgery after radiation (42% [30/72]) than in patients treated with postoperative radiation (17% [12/69]) (P<.004). Revascularized flaps helped ameliorate the effects of radiation before surgery; 56% (23/41) of the patients who received pectoralis flaps were G-tube dependent, while the rate of G-tube dependence in the revascularized flap group was 23% (7/31) (P<.004). Hospitalization was longer in the pectoralis group (14 days) than the revascularized flap group (12 days) (P<.006). CONCLUSION: Patients who undergo reconstruction with a pectoralis flap have significantly higher minor complication rates, a higher rate of G-tube dependence, and longer hospitalization than patients who undergo reconstruction with a soft-tissue revascularized flap.

Female↗
PubMed2002

[Major myocutaneous pectoralis flap for the head and neck repair].

The AA. report the outcomes of a retrospective study done with 22 patients operated on the mouth cavity, pharynx and larynx, all in advanced evolutive stages. The repair take place through a myocutaneous flap of pectoralis major muscle. Viability was excellent in 77.3% percent of patients, regular in 27.3% and disgusting in 9.1%. Swallowing normal in 54.5%, regularly in 27.3% and bad in 18.2%. Language was normal in 45.4% of cases, intelligible in 36.4% and almost incomprehensible in 18.2% of members of the whole group.

Aged↗
PubMed1975

A variant of Poland syndrome: report of case.

A variant case of Poland syndrome is reported, with the patient presenting major unilateral anomalies in the sternocostal head of the left pectoralis major muscle and a shorter left arm and hand. No pre-natal history of attempted abortion or using toxic or teratogenic drugs could be elicited. The variability of the upper extremity anomalies and the frequency of major ipsilateral defects of the skeletal and genite-urinary systems, the associated diseases, and the diagnosis and management of these patients are briefly discussed.

Adult↗
PubMed1991

Composition of myofiber types in the pectoral girdle musculature of sheep.

The muscles of the pectoral girdle in domestic animals attach the forelimbs to the trunk and function as the suspensory apparatus. In the present study the composition of the pectoral girdle musculature of sheep by myofiber types was examined. Myofibers showing a strong reaction for alkali-stable myosin ATPase were classified into fast-twitch/glycolytic (FG) myofibers with a weak activity for NADH tetrazolium reductase (NADH-TR) and fast-twitch/oxidative/glycolytic (FOG) myofibers with a moderate and strong NADH-TR activity. Myofibers showing a weak reaction for alkali-stable myosin ATPase and a strong activity for NADH-TR were classified as slow-twitch/oxidative (SO) myofibers. The SO myofibers that showed a granular and striped pattern of diformazan deposits in NADH-TR activity were classified as SO-1 myofibers, whereas the SO myofibers characterized by a reticular pattern of diformazan deposits were classified as SO-2 myofibers. The trapezius, rhomboideus cervicis, and pectoralis descendens muscles situated superficially in the cranial regions of the back and chest had about 50% SO (SO-1 plus SO-2) myofibers. The deeply situated serratus ventralis cervicis and thoracis muscles had 37.5% SO myofibers. These five muscles included more SO-2 myofibers with large diameters than did all other muscles, and had about 50% and more cross-sectional area of SO myofibers. The other muscles had less than 32% SO myofibers and fewer SO-2 myofibers. The FOG and FG myofibers accounted for 50% or less in the muscles examined. Many muscles of the pectoral girdle had many fast-twitch (FOG plus FG) myofibers; they seem to meet locomotory requirements. In the pectoral girdle musculature, the SO myofibers were not necessarily distributed more in the deep regions than in the superficial regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Implant breast reconstruction using acellular dermal matrix.

Thirteen breast reconstructions in 11 patients, averaging 58 years of age, underwent mastectomies. The technique uses a saline implant either totally or partially covered with a human acellular dermal matrix. The mean postoperative follow-up time was 14 months. Ninety percent of the patients were considered high risk; the thickness of the human acellular dermal matrix was an average of 1.3 mm, with an average area per breast of 121 cm. There were 12 successful breast reconstructions (92%) that provided stability, increased soft tissue padding, which allowed a greater resemblance to normal breast shape and decreased rippling and implant visibility. The graft was used in an onlay fashion or as an extension of the pectoralis major muscle that covers the implant. A representative histologic cross-section of well-integrated human acellular dermal matrix is presented. The use of a human acellular dermal matrix in breast reconstruction is an alternative protocol in high-risk patients, resulting in a minimal increase in operative time and a decrease in morbidity compared with more extensive procedures.

Adult↗
PubMedDate not supplied

Giant recurrent fibromatosis of the breast: a case report. Clinical features and implications for treatment.

Fibromatosis of the breast is a benign but locally aggressive neoplasm, which has been described under various names including extra-abdominal desmoid tumour and aggressive fibromatosis. It is a rare condition, accounting for approximately 0.2% of all solid tumours of the breast. Clinically and radiologically the lesion mimics breast cancer and the definitive diagnosis is provided by histology. A high risk of local recurrence is a characteristic of this disease. Radical excision of the tumour with clear histological margins decreases the likelihood of recurrence. The possible association between breast implants and mammary fibromatosis has been reported. In this study we report a case of giant fibromatosis of the breast observed in a young patient and its extensive recurrence, involving all quadrants of the breast, the pectoralis major muscle, the rectus abdominis muscle sheath and the costal layer. The main clinical and pathological characteristics of this rare disease are illustrated, emphasizing the difficulties encountered both in the diagnosis of the primary lesion and in the management of its giant recurrence, particularly as regards the possibility of obtaining a radical surgical excision and the option of performing breast reconstruction.

Adult↗
PubMed2003

Variation in fibroblast growth factor response and heparan sulfate proteoglycan production in satellite cell populations.

Variation in the responsiveness of myogenic satellite cell subpopulations to mitogenic stimuli was examined in cells isolated from the turkey pectoralis major muscle. Faster growing clonal cell populations were more responsive to fibroblast growth factor (FGF-2) and expressed greater levels of FGF-2 and FGF receptor-1 at the onset of proliferation than did slower growing cells. Faster growing clones also expressed higher levels of heparan sulfate proteoglycans (HSPG), especially during differentiation, than did slower growing clones. HSPG, which is important in FGF receptor signaling, increased during proliferation of all clones tested and decreased in all but one of the clones during differentiation. Slower growing clones increased their expression of FGF receptor-1 through proliferation and differentiation. However, expression of the receptor in faster growing clones decreased during differentiation. The FGF receptors-2 and -3 were not detected on turkey satellite cells or myotubes by reverse transcriptase-polymerase chain reaction methodology. These results demonstrate that there is heterogeneity in the properties and responsiveness of satellite cell populations derived from single muscles. Satellite cells that differ in proliferation rates differ in responsiveness to FGF-2, and in the expression of FGF-2, FGF receptor-1, and HSPG.

Animals↗
PubMed1993

[Reconstructive results in 31 cases using a myocutaneous flap from pectoralis major].

A study was carried out about the general features of myocutaneous flap taken from the pectoralis major muscle. This flap is employed in the reconstructive step after ablative surgery for carcinomata of the oropharynx, tongue, floor of the mouth, hypopharynx and other growths of the neck with skin involvement. The AA. review their 31 cases results, both cosmetic and functionally, and consider that the end-condition is favorable and hopeful in the whole.

Carcinoma↗
PubMed1986

The clavicular head of pectoralis major musculocutaneous free flap.

A new free flap is described based on the deltoid vessels of the acromiothoracic axis. The flap is comprised of the clavicular head of pectoralis major muscle with overlying skin. It is also possible to harvest vascularised clavicular bone with the flap. The vascular anatomy is reviewed and the technique of raising the flap described. Its clinical application is illustrated with five cases. Four of these were intra-oral reconstructions and the fifth a composite osteo-musculocutaneous flap to a lower limb following trauma.

Adult↗
PubMed1991

Technical considerations for prophylactic mastectomy in patients at high risk for breast cancer.

A study of 5 patients and 10 mastectomy specimens was performed to identify the extent of surgery necessary to completely remove all breast tissue in patients having prophylactic mastectomies. A standard total mastectomy performed for breast cancer was shown to frequently leave breast tissue within the superficial pectoralis major muscle and the lower skin flap. Frozen section analysis of margins was found to be essential to clear the axillary extension of the breast and lower skin flap in particular. The value of more extensive surgery to remove all glandular elements of the breast in the high-risk patient remains to be demonstrated.

Adult↗