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At least 1,351 records · Page 75Linked to original sources
PubMed1979

[Anomalies of the upper arm--tuberculosis cutis luposa of the hand].

An anomaly of the right pectoralis major muscle is reported. Two muscle bundles are demarcated from the pars abdominalis. Some fibres of these bundles radiate into the distal part of the normal insertion on the humerus; most fibres, however, insert into an accessory tendon which attaches to the medial humeral epicondyle. The medial intermuscular septum is fixed to this tendon. The septum is traversed by filaments of the triceps muscle. Fibres of the triceps muscle also surround the ulnar nerve and the ulnar collateral blood vessels before they pass through the medial part of the septum. These findings are discussed under functional aspects. Catamnestically a tuberculosis cutis luposa exists on the right hand. A patho-causal connection between the anomaly and the tuberculosis of the skin cannot be excluded, because this may arise easier in an area of disturbed blood supply.

Aged↗
PubMed1997

Effect of electrical stimulation in combination with calcium chloride or sodium chloride treatments at constant ionic strength on moisture binding and textural quality of early-harvested breast fillets.

The objective of this study was to assess the effects of a CaCl2 or NaCl treatment combined with electrical stimulation (ES) on textural and moisture binding of early-harvested chicken breast fillets. During exsanguination, half the birds were subjected to ES, and then all carcasses were aged for 30, 60, 90, or 120 min before excising both Pectoralis major muscles. Half the muscles were chilled with a NaCl solution and half with a CaCl2 solution. Effects of ES and chill medium composition on meat pH, moisture absorption, cooking loss, and shear value of the fillets were assessed. The ES reduced meat pH for the NaCl-treated muscles, but had no effect on those treated with CaCl2 of on moisture absorbed during chilling. Cooking loss was greater for the CaCl2-treated than NaCl-treated muscles and for muscles from stimulated birds that were excised more than 30 min post-mortem. Shear values were unaffected by chilling medium composition. However, even though shear values for both ES and unstimulated birds declined as aging time increased, the rate of decline was greater, and ultimate shear value lower, for muscles from ES birds. Results indicate that, although ES might offer some advantage in improving the tenderness of early-harvested breast fillets, combining ES with CaCl2 treatment offers no real advantage. Moreover, reductions in moisture binding properties by these technologies might limit applicability in some commercial environments.

Absorption↗
PubMed1983

The pectoralis major myocutaneous flap: an angiographic study.

A new era in head and neck reconstruction has been opened with the use of myocutaneous flaps. The pectoralis major myocutaneous flap is considered the most reliable of its kind but flap failures still occur secondary to tension and infection. Our standard procedure has been to follow the acromioxiphoid line as a guide to the location of the blood supply of the pectoralis major muscle. We have noticed in the operating room and during cadaver dissection that the vascular supply is sometimes more laterally located than usually described. A review of the vascular supply of this anatomic area using angiographic studies of the subclavian and its branches is presented, with important findings critical to the surgical technique used to protect the flap's blood supply.

Adult↗
PubMed1983

The lateral pectoral composite flap in one-stage reconstruction of the irradiated mandible.

We present a composite flap based on the musculature of the anterolateral thorax that allows immediate reconstruction of the mandible through the interposition of vascularized bony fifth rib. While the vascular pedicle remains the pectoral branch of the thoracoacromial artery, the pectoralis major muscle can be spared largely intact. The lateral position of the composite rib segment ensures a purely bony composition, while the lateral skin island remains largely hairless. Despite the unfavorable conditions of massive tumor size and prior irradiation attending the clinical cases presented, the complication rate was acceptable, with only one flap loss, and this followed technical error.

Adult↗
PubMed2005

Salvage of infected prosthetic grafts of the great vessels via muscle flap reconstruction.

OBJECTIVE: The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment. In the present article, we report our experience utilizing pectoralis major muscle flaps, occasionally coupled with latissimus dorsi, rectus abdominis, and/or serratus anterior flaps, to wrap infected grafts and fill dead space. PATIENTS: Between 1990 and 2004, 10 patients were brought to our attention with infections of prosthetic grafts of the great vessels (7 men and 3 women; mean age, 53 years). Infections in nine patients involved an ascending aortic graft, while one patient had an infected pulmonary artery graft. DESIGN: Following diagnosis and exploration, an initial debridement is performed, followed by 48 h of antibiotic irrigation. A definitive muscle flap procedure is then utilized to fill dead space and clear the infection, followed by an appropriate antibiotic regimen. RESULTS: The infections in all 10 patients were cleared using the muscle flap procedure. Two patients required a tapered-dose regimen of oral steroids, one of whom also required a secondary flap procedure due to the advanced stage of infection. Two other patients later died due to unrelated complications; however, autopsies revealed that operative sites had healed successfully. Patients were followed up for a period of 2 months to 2 years, and recurrence was not found. CONCLUSIONS: Our outcomes suggest that muscle flap procedures, specifically utilizing the pectoralis major and regional muscles, should be kept in mind in the management of life-threatening infections of aortic grafts. Due to the limited number of patients in this study, we feel more research with a larger volume of cases is warranted.

Aged↗
PubMed1984

The pectoralis major costomyocutaneous flap for mandibular reconstruction.

In this paper we present a series of 14 pectoralis major costomyocutaneous flaps employed on patients who required mandibulectomy for oral tumors. Experience with this previously described technique is analyzed and its complications are presented. Although the pectoralis major muscle does not originate from the ribs, there appears to be enough blood supply by means of the delicate areolar connections and the periosteum to sustain the costal segment. In an attempt to improve the blood supply by means of the perichondrium, we have included a portion of the costal cartilage. In our series there were three failures resulting probably from technical errors. Apart from these, the results were satisfactory. However, the use of this procedure is relatively recent, and its long-term results are unknown at the moment.

Adolescent↗
PubMed1986

A comparison between sternum and rib in osteomyocutaneous reconstruction of major mandibular defects.

Following major mandibular resection for intraoral malignancy, 6 patients underwent reconstruction using rib and 22 patients underwent reconstruction using the outer table of the sternum; the pectoralis major muscle was used as the vascular carrier for both bone and skin in all patients. Five of the 6 patients in the rib group encountered major complications. In the sternal group, loss of bone occurred in only 2 of 22 patients. Those aspects of technique considered important to the outcome are detailed. Results are discussed in terms of bone survival, intraoral features including denture placement, and the patient's appearance. The sternal transfer has consistently shown itself to be superior to rib, in terms of both early morbidity and later functional and aesthetic results. It is our present method of choice for reconstruction following major intraoral resection.

Bone Transplantation↗
PubMed1984

Poland's syndrome associated with childhood non-Hodgkin's lymphoma.

Poland's syndrome is a congenital absence of the sternal portion of the pectoralis major muscle, often associated with ipsilateral upper-limb anomalies. We describe two children with non-Hodgkin's lymphoma associated with Poland's syndrome, ie, an association between childhood cancer and congenital anomalies previously unreported and unlikely to be due to chance. In addition, we report another case of acute leukemia in a child with Poland's syndrome. In view of the rarity of Poland's syndrome in the general pediatric population, we conclude that there is an increased association of the syndrome with both leukemia and non-Hodgkin's lymphoma, the biologic basis of which is unclear.

Adolescent↗
PubMed1986

Arm lymphedema in patients treated conservatively for breast cancer: relationship to patient age and axillary node dissection technique.

Arm lymphedema (ALE) was evaluated in 74 patients treated conservatively for breast cancer. ALE was defined based upon measurements performed upon 35 volunteer subjects who did not have and were never treated for breast cancer. Multiple variable statistical analysis of 74 breast cancer patients revealed that age at diagnosis was the most important factor related to the subsequent development of ALE. ALE appeared in 7 of 28 patients (25%) 60 years of age or older but in only 3 of 46 (7%) younger patients (p less than 0.02). Axillary node dissection (AND) was the only other statistically significant factor. For the younger patients, obesity and post-operative wound complications appeared to be contributing factors. For the older patients, AND technique was the only significant factor. ALE developed in only 1 of 10 (10%) of the older patients who underwent AND without splitting the pectoralis minor muscle (PMM), but in 6 of 11 (55%) who underwent AND with PMM split (p less than 0.03). Splitting the PMM during AND did not yield more lymph nodes for pathological analysis nor did it yield a higher incidence of patients with nodal metastases. Neither the use of lymph node radiation therapy fields, radiation to the full axilla, nor systemic chemotherapy was associated with ALE. We conclude that older patients are at higher risk of ALE and that this complication can possibly be reduced by not splitting the PMM during axillary node dissection.

Adult↗
PubMed2001

Accelerated tissue aging and increased oxidative stress in broiler chickens fed allopurinol.

Uric acid has been hypothesized as being one of the more important antioxidants in limiting the accumulation of glycosylated endproducts in birds. Study 1 was designed to quantitatively manipulate the plasma concentrations of uric acid using hemin and allopurinol while study 2 determined their effects on skin pentosidine, the shear force value of Pectoralis major muscle, plasma glucose, body weight and chemiluminescence monitored oxidative stress in broiler chickens. Hemin was hypothesized to raise uric acid concentrations thereby lowering oxidative stress whereas allopurinol was hypothesized to lower uric acid concentrations and raise measures of oxidative stress. In study 1 feeding allopurinol (10 mg/kg body weight) to 8-week-old broiler chicks (n=50) for 10 days decreased plasma uric acid by 57%. However, hemin (10 mg/kg body weight) increased uric acid concentrations 20%. In study 2, 12-week-old broiler chicks (n=90) were randomly assigned to either an ad libitum (AL) diet or a diet restricted (DR) group. Each group was further divided into three treatments (control, allopurinol or hemin fed). Unexpectedly, hemin did not significantly effect uric acid concentrations but increased (P<0.05) measures of chemiluminescence dependent oxidative stress in both the DR and AL birds probably due to the ability of iron to generate oxygen radicals. Allopurinol lowered concentrations of uric acid and increased (P<0.05) the oxidative stress in the AL birds at week 22, reduced (P<0.05) body weight in both the AL and DR fed birds at 16 and 22 weeks of age, and markedly increased (P<0.001) shear force values of the pectoralis major muscle. Skin pentosidine levels increased (P<0.05) in AL birds fed allopurinol or hemin fed birds, but not in the diet restricted birds at 22 weeks. The significance of these studies is that concentrations of plasma uric acid can be related to measures of oxidative stress, which can be linked to tissue aging.

Aging↗
PubMed2004

Augmentation mammoplasty using the retrofascia approach.

In augmentation mammoplasty, the selection of placement for implants is based on the characteristics of each patient and the tissue conditions to ensure an optimal covering of these. The location must not be arbitrarily based on the preferences of the surgeon and the patient, but must ensure adequate tissue covering, thus minimizing shorts and long-term risks. Retromammary, retropectoral, and total and mixed retromuscular implants have been used. The retrofascia location of the mammary prosthesis reported in this article was described for the first time in the year 2000. This retrofascia technique refers to the collocation of the implant behind the fascia and in front of the pectoralis major muscle with the goal of achieving proper covering and good support of the implant. This is a nonrandomized prospective study investigated 110 cases of mammary hypoplasia and ptosis levels 1 and 2 from October 2001 to October 2002 with an average follow-up period of 1 year. Periareolar incisions were used in the retrofascia collocation of the mammary implant. The types of implants used included texturized silicone gel (85%) and smooth silicone gel (15%). As demonstrated by the findings, this surgical technique can achieve a good support to keep the prosthesis in an adequate position, maintaining the superior pole with a very natural projection. The incidence of complications was 7.6%, the most frequent of which was capsular contracture (3.53%).

Adolescent↗
PubMed1989

Clavicular division technique. A new approach for lengthening the pectoralis flap.

Complications associated with using the pectoralis major myocutaneous flap increase significantly when a portion of the paddle is randomized and/or the flap is closed under tension. The clavicular division technique was devised to increase the length of the flap to help alleviate this problem. Thirty pectoralis major muscle flaps were dissected in fresh cadavers, using the clavicular division technique. The length of the flap after transposition was measured and recorded before and after clavicular division. The distance from the sternal notch to the clavicular division point was also recorded. The average gain in length was found to be 2.9 cm, with a range of 0.5 cm to 6.5 cm. The clavicular division technique has been used since in five patients. The increase in length has allowed us to discard some or all of the random portion of the flap. We advocate the use of this procedure on any patient where the surgeon is concerned about the viability of the random portion of the flap and/or when it is felt that the tension on the suture line is excessive.

Clavicle↗
PubMed2006

Preservation of lateral thoracic artery to improve vascular supply of distal skin without compromising pedicle length in harvesting pectoralis major myocutaneous flap.

The pectoralis major myocutaneous (PM) flap is supplied by three arterial systems. The lower chest skin of the PM flap is mainly supplied by the branches of lateral thoracic artery and internal mammary artery. The conventional harvesting technique for head and neck reconstruction utilizes single arterial supply from the pectoral branch of thoracoacromial artery. The distal skin island of PM flap is therefore compromised and requires indirect blood supply by communicating vessels. In harvesting the PM flap, the pectoralis minor muscle is divided to preserve the lateral thoracic artery and its blood supply to the lateral distal skin island of PM flap without compromising the pedicle length for head and neck reconstruction. Six PM flaps were harvested for reconstruction of head and neck defects with preservation of both the pectoral artery and lateral thoracic artery. The focal pint of swing of all six flaps was at the same point just below the mid-point of clavicle for both pectoral artery and lateral thoracic artery. The flaps can reach the oral cavity, tonsil or hypopharynx without limitation and there is no flap necrosis. In conclusion, the lateral thoracic artery can be preserved without compromising the pedicle length of PM flap. It is a recommended technique to improve the blood supply to the distal skin of PM flap.

Head and Neck Neoplasms↗
PubMed1978

Vascular origin of Poland syndrome? A comparative rheographic study of the vascularisation of the arms in eight patients.

Vascularization of the arms has been studied by impedance plethysmography (rheography) in eight children with Poland syndrome, a common malformation characterized by unilateral hand anomaly and ipsilateral aplasia of the inferior head of the pectoralis major muscle. A marked decrease of the velocity of the systolic increase in the arterial volume (Velm) was shown in the affected arms, and the difference between the two arms was significantly higher in the patients than in a control group (P less than 0.02). These results, which are also observed in stenotic atherosclerosis, support the hypothesis of hypoplasia of the ipsilateral subclavian artery as the origin of the malformation, although a local anomaly in arterial-wall viscosity cannot be ruled out. The opacification of the aortic arch in another patient confirmed this hypothesis. Aortography in further patients will be necessary to substantiate our results. However, this technique is not without danger and should only be used during the first months of life when a vascular operation can be envisaged.

Adolescent↗
PubMed2006

Subpectoral implantation of the vagus nerve stimulator.

OBJECTIVE: To report the technique of subpectoral (SP) implantation of the vagus nerve stimulator (VNS) generator. METHODS: We retrospectively reviewed and compared demographics and complications from patients receiving either subcutaneous (SQ; n = 107) or SP (n = 138) VNS implants, performed by one surgeon (WKD) between 1999 and 2003. Selection of implant location was made during the preoperative surgeon-patient consultation on the basis of surgeon recommendation and patient preference. RESULTS: The standard VNS generator implantation is performed within a SQ pocket in the left infraclavicular region of the chest. We have modified this technique by placing the generator into a deeper pocket SP, beneath the pectoralis major muscle, while tunneling the electrodes SQ in the usual fashion. The SP group was substantially younger (median age 19 yr) compared with the SQ group (median age 29 yr). At an average follow-up of 52 months for SQ implants and 28.4 months for SP implants, there were 2.9% infections per patient in the SQ group and 2.5% infections per patient in the SP group. There were three cases of excessive generator mobility in the SQ group; no cases occurred in the SP group. CONCLUSION: The SP implantation technique provides an attractive alternative to SQ VNS implantation. With increased soft tissue coverage, we provide improved cosmesis, increased wound durability to tampering and trauma, and a comparable infection rate with the SQ group.

Adolescent↗
PubMed1989

Reconstruction of intermediate sized mucosal defects with the pectoralis major myofascial flap.

An uncovered pectoralis major muscle flap (PMF) was utilized in 12 patients for reconstruction of mucosal defects of intermediate size. The PMF is nonhair-bearing and thinner and more flexible than the myocutaneous flap. Epithelialization of the PMF occurs slowly but results in a mucosal surface that is nonkeratinized and closely resembles normal. The paddle of the PMF contracts as much as 75% during healing. However, none of our patients developed deficits attributable to contracture of the flap, presumably because only modest-sized defects were repaired. The PMF is useful for reconstruction of intermediate-sized defects approximately 6 x 6 cm, defects that are too large to close with local flaps and tend to be too small to be closed conveniently with a bulky myocutaneous flap. Contracture of the PMF precludes its use for reconstruction of large defects.

Aged↗
PubMed1997

Anatomical study of the pectoral branch of thoracoacromial artery.

Reconstructive surgery uses various musculocutaneous flaps following resection of head and neck malignant tumor. Numerous anatomical studies have reported that the thoracoacromial artery arises from the axillary artery, but those findings have not been completely confirmed. The aim of this study was to investigate the path from the origin of the thoracoacromial artery until its pectoral branches enter the pectoralis major muscle. The following results were obtained. 1. There were no cases in which the thoracoacromial artery arose from the third part of the axillary artery. 2. There were differences between the left and right sides in the vertical and horizontal origins of the thoracoacromial artery in relation to the clavicle and median line. 3. Pectoral branches showed a single origin from the thoracoacromial artery most frequently. 4. Pectoral branches descend in parallel to the median line most frequently on the right side and descended medially to the median line most frequently on the left side. 5. The largest number of branches approached the venter vertically at the height of the third rib. There findings suggest that, during operations involving a musculocutaneous flap, the surgeon must pay attention to the differences in vascular morphology of the right and left sides.

Aged↗
PubMed1985

Osteoinduction in rhesus monkeys using demineralized bone powder allografts.

This experiment tested the osteoinductivity of demineralized bone powder (DBP) in nonhuman primates. Six DBP implants were implanted subcutaneously close to the pectoralis major muscle in each of four rhesus monkeys. Excisional biopsies were obtained 20, 40, and 72 days after implantation and were processed for light and electron microscopy. Decalcified and undecalcified sections of the implants were studied. Large numbers of undifferentiated mesenchymal and fibroblast-like cells were observed around and within the DBP matrix particles on day 20. Cartilage formation was also evident at that time and had increased by day 40, when chondroid bone also appeared. By day 72, the implants showed mature (lamellar) and immature (woven and chondroid) bone and bone marrow formation. Areas of DBP that were incorporated within the induced bone contained empty lacunae and stained similarly to mineralized bone. It was concluded that allogenic DBP can induce bone formation in monkeys. The results justify the use of DBP as a bone-banked material to induce bone formation in humans.

Animals↗