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Objective:To explore the advantages and value for clinical application of clavicle segment osteotomy approach with pectoralis major muscle pedicle in surgical resection of posterior brachial plexus tumour.Methods:From April 2010 to December 2020, 6 patients with brachial plexus tumour behind the clavicle were treated. Two patients had the tumour on the left brachial plexus and 4 on the right. Two patients had the tumours located in the upper trunk of brachial plexus, 2 in the middle trunk, 1 in the medial plexus and 1 in the posterior bundle. The neurological function evaluation were grade II in 3 cases and grade III in 1 case preoperatively. The tumours sized from 3.0 cm× 3.0 cm×2.0 cm to 11.0 cm×8.0 cm×6.0 cm. The clavicular segment osteotomy approach with the pedicle of the pectoralis major was applied in order to expose the surgical field and remove the nerve tumour. All patients underwent regular postoperative outpatient clinic follow-up to record the sensation of the affected limb and the recovery of muscle strength, tumour recurrence and fracture healing.Results:In the operation, it was found that there was still a little glial-like tissue in the nerve sheath after complete dissection of the tumours in 2 patients. Postoperative pathological examination reported that there were 4 schwannoma, 1 malignant peripheral schwannoma and 1 neurolipoma. The postoperative follow-up lasted for 6 to 34 months, with an average of 12.8 months. All patients showed no symptoms of brachial plexus injury or tumour recurrence. The clinical symptoms were relieved or disappeared. The neurological function evaluation reached grade III in 5 patients and grade IV in 1 case. At the same time, the internal fixation of the clavicle was satisfactory and achieved bone union in all cases. Fracture healing time was 2.5 to 4.5 months, with an average of 3.2 months. The internal fixation was removed from 3 patients after operation in 1 year. No obvious limb movement disorder and periarthritis of shoulder and other complications occurred.Conclusion:The transclavicular osteotomy approach with the pedicle of the pectoralis major can fully expose the anatomical alignment of the brachial plexus and the relationship adjacent and between the tumour and the surrounding tissues in the surgery for a brachial plexus tumour behind the clavicle, which is helpful for a complete tumour resection. It is a feasible method to treat brachial plexus tumour behind the clavicle by finding residual tumour-like tissue, reducing the risk of surgery and tumour recurrence, and providing excellent blood supply to the osteotomy segment of the clavicle to promote fracture healing.
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Objective@#To analysis and summarize the experience of surgical treatment of deep sternal infection caused by residual epicardial pacing.@*Methods@#Retrospective analysis of 78 patients with deep incision infection due to residual epicardial pacing lead after heart disease were selected from the Seventh Medical Center of PLA General Hospital from May 2014 to December 2018. Including 47 males and 31 females, aged 3-72 years old. 38 patients with heart valve surgery(including 18 cases with aortic valvuloplasty, 9 cases with aortic valve replacement, 11 cases with double valve replacement), 14 cases with coronary artery bypass grafting, 26 cases with congenital heart disease surgery(10 cases with atrial septal defect repairment, 11 cases with ventricular septal defect repairment, 5 cases with complex malformation surgery). All patients were infected with sternal incision due to incomplete extraction of the cardiac pacing lead, and treated with the muscle flap turnover operation. The treatment time was 1-5 years after the cardiac surgery in 32 cases, and 46 cases in 1 year.@*Results@#There was no death in the study. 70 cases were cured in stageⅠ, 5 cases in stageⅡ, and 3 cases were cured after re-operation. 71 cases were followed up for 1 year, there was no recurrence of wound infection.@*Conclusion@#The operation of pectoralis major muscle flap turnover has opened up a new approach for the treatment of thoracic incision infection caused by residual epicardial pacing lead after cardiac surgery, and it is worth popularizing in clinical practice.
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The musculus sternalis is an anatomical variant that occurs in 3-8 % of the world population and its incidence is higher in women. It can be found unilaterally or bilaterally and is located in the anterior wall of the thorax, where its fibers run parallel to the sternum and superficial to the medial part of the pectoralis major muscle. The main objective of this study was to quantify the incidence of musculus sternalis in the population of Caldas (Colombia) and, therefore, 68 cadavers of adult individuals were used during a period of twenty years to determine the incidence of this muscle and describe its anatomical characteristics. Two cadavers had this muscle, which was equivalent to 2.94 % of the sample, where one was located unilaterally and in other bilaterally. In the case of unilateral presence, the muscle presented an oblique direction thatdoes not coincide with any subtype of the classification given for these muscles. In bilateral presentation, both muscles were continuous at their upper ends with the respective sternocleidomastoid muscle. In addition, the right musculus sternalis had a digastric shape, which also does not coincide with any subtype of the classification.
El músculo esternal es una variante anatómica que se presenta entre el 3 % y 8 % de la población mundial y su incidencia es mayor en mujeres. Puede hallarse de manera unilateral o bilateral y se localiza en la pared anterior del tórax, donde sus fibras corren paralelas al esternón y superficial a la región medial del músculo pectoral mayor. El objetivo del presente estudio fue cuantificar la incidencia del músculo esternal en la población de Caldas (Colombia). Fueron revisados 68 cadáveres de individuos adultos durante un lapso de doce años, con el fin de determinar el grado de presencialidad del músculo y sus características anatómicas. Dos cadáveres, que equivale al 2,94 % de la muestra, presentaron el músculo esternal, uno de manera unilateral y el otro bilateral, a los cuales se les hizo una descripción anatómica detallada. En la presentación unilateral, el músculo presentó una dirección oblicua que no coincide con ningún subtipo de la clasificación dada para estos músculos. En la presentación bilateral, ambos músculos se continúan por su extremo superior con el respectivo músculo esternocleidomastoideo. Además, el músculo esternal derecho tiene una configuración digástrica, que tampoco coincide con ningún subtipo de la clasificación.
Subject(s)
Humans , Male , Female , Pectoralis Muscles/anatomy & histology , Sternum/anatomy & histology , Cadaver , Colombia , Anatomic VariationABSTRACT
To investigate the therapeutic effect of pectoralis major muscle flap transplantation in thoracotomy patients with sternal infection. Methods From January 2014 to December 2017, the treatment group of 39 patients with thoracic bone infection after cardiac surgery was used pectoralis major muscle flap to close the wound, while 26 patients were treated by debridement and vacuum sealing drainagea at the same time as the control group. The hospitalization time, hospital costs, number of operations, satisfaction survey, and relapse rate were compared between the those. Results Compared with the control group, the treatment group has the benefit of shorter hospitalization time [(18. 1 ± 3. 8)days vs. (36. 7 ± 11. 4) days], less hospital costs [(19429 ±4088)yuan vs. (33495 ±10712)yuan], less number of operations [(1. 1 ±0. 3)times vs. (2. 4 ±0. 8)times], higher level of satisfaction(56. 4％ vs. 30. 8％), lower relapse rate(5. 1％ vs. 26. 9％), the differences are statistically significant(all P <0. 05). Conclusion Thoracic reconstruction with pectoralis major muscle flap is an effective treatment for sternal infection in postcardiac surgery.
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SUMMARY: Anomalous muscle slips of pectoralis major have been reported on several cases in the literature. Among these, chondroepitroclearis muscle is an extremely rare aberrant muscular slip originating from the pectoral region. During an educational dissection, chondroepitroclearis muscle was found on the right side in a Korean cadaver. Tendinous muscular slip originated from pectoralis major muscle, crossing the neurovascular bundle in the arm, and inserted onto medial epicondyle of the humerus. Clinical significance of these anomalous slip can cause median nerve entrapment and functionally limited movement of the humerus. We report a case of tendinous chondroepitroclearis muscle and discuss its clinical and embryological significance.
RESUMEN: En la literatura se han reportado fascículos anómalos del músculo pectoral mayor. Entre estos, el condroepicondilar medial es un fascículo muscular aberrante extremadamente raro que se origina en la región pectoral. Durante una disección educativa, se encontró esta variación en el lado derecho de un cadáver coreano. El fascículo muscular tendinoso se originó a partir del músculo pectoral mayor, cruzando el paquete neurovascular en el brazo, y se insertó en el epicóndilo medial del húmero. La importancia clínica de estos fascículos anómalos radica en la posibilidad de causar el atrapamiento del nervio mediano, causando un movimiento funcionalmente limitado del húmero. Divulgamos un caso de músculo condroepicondilar medial tendinoso y discutimos su significado clínico y embriológico.
Subject(s)
Humans , Female , Aged , Pectoralis Muscles/anatomy & histology , Anatomic Variation , Median Nerve/anatomy & histology , CadaverABSTRACT
@#Objective To study the effect of deep sternal wound infections（DSWIs）treated by the techniques of pectoral major muscular(PM) turnover and non-suture remain after the wound restitution. Method We retrospectively analyzed the clinical data of 23 patients with DSWIs in our hospital between June 2016 and December 2016. There were 13 males and 10 females at age of 4-73(54.5±19.5) years. There were 8 patients with concomitant diabetes mellitus and 1 patient with chronic obstructive pulmonary disease(COPD) and brain infarction. Eigteen patients were of type Ⅱ, 5 patients of type Ⅲ according to Pairolero’ classification in the DSWIs. Five patients were with remaining abscess cavity in the mediastinum by thoracic compute tomography(CT). Under general anesthesia the DSWIs debrided thoroughly. The PM elevated from the anterior pectoralis major fascia off subcutaneous tissue to lateral to anterior axillary line, the PM cutted off, then made to the muscle flap, turnover PM flap filled and fixed to sternal wound by lighten tensile suture, the subcutaneous tissue and skin sutured by cutting full-thickness. Results The sternal reconstruction after debridement of the sternal wound was used by bilateral PM flap in the 17 patients, unilateral PM in 6 patients. There were 21(91.3%) patients in stage Ⅰ healing, 2 patients deferment healing of local cut skin without reoperation. There were 22 patients with non-paradoxical breathing during the postoperation. One death resulted from multiple-organ failure of the concomitant disease. The average of hospital day was 10.6 days. The wound healing was good by chest CT at 1 month after the operation. Conclusion The sternal forming by the technique of the PM flap turnover, without remain of fremde stoffe in wound for DSWIs is distinctive method, evident effect.
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Objective To summarize the experience on the treatment of sternal infection after cardiac surgery,introduce the pectoralis major myocutaneous flap plasty.Methods The clinical data of 247 patients with sternal infection after cardiac surgery in our hospital from January 2014 to July 2017 were retrospectively analyzed.Including 176 males and 71 females,aged from 3 months to 92 years old(162 cases over 60 years old).Results 4 cases died postoperation.226 cases with stage Ⅰ healing,17 cases with stage Ⅱ healing(4 cases of tuberculosis infection cured by anti-tuberculosis treatment).201 cases were followed up,7 cases wound infection relapsed(6 cases with replacement of aortic dissection with artificial blood vessel,and 1 with congenital heart disease).The others had no recurrence.Conclusion The pectoralis major muscle flap inversion plasty for treatment of the median sternal and mediastinal chest incision infection after cardiac surgery can effectively cure the wound,shorten the treatment time,and prevent the secondary complications caused by wound infection.Most patients can obtain primary healing.
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Objective To summarize the experience of treating sternal infection combined with mycobacterium tuberculo-sis infection after cardiac surgery, introduce the pectoralis major muscle flap inversion plasty .Methods The clinical data of patients with sternal infection combined with mycobacterium tuberculosis infection after cardiac surgery in our hospital from Jan-uary 2012 to July 2017 were retrospectively analyzed.Results In the patients with sternal infection combined with mycobacte-rium tuberculosis infection after cardiac surgery, 8 cases were primary healing, 2 cases were delayed healing, and 1 case was healing after reoperation .Conclusion The pectoralis major muscle flap inversion plasty for treatment of sternal infection com-bined with mycobacterium tuberculosis infection after cardiac surgery can effectively cure the wound , shorten the treatment time, and prevent the secondary complications caused by wound infection.Most of the patients can obtain primary healing.
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Background and purpose:The pedicled pectoralis major myocutaneous lfap has been a common choice of tissue lfaps for head and neck reconstruction. Nowadays, with rapid advancement in microsurgery, free lfaps gradually replace the pedicled lfaps. However, not all patients are good candidates for reconstruction surgery using free tissue lfaps. Adjacent pedicled lfaps are safer and more reliable. This paper explores potential application of pedicled pectoralis major myocutaneous flap in reconstruction of complex surgical defects following resection of advanced head and neck malignancies through modification of their preparation and repair method.Methods:Flap design scheme and method of preparation were modiifed to improve the pectoralis major muscle lfap. Fifty-one patients with surgical defects from resection of head and neck malignancies received reconstruction surgery using modiifed pectoralis major muscle lfaps.Results:Modiifed pectoralis major muscle lfaps survived completely in 51 patients. The area of defect regained its shape and appearance after reconstruction surgery. The area of defect obtained excellent functional recovery. Postoperative functional injuries to the donor sites were minimized.Conclusion:Modiifcation in designing and preparing method of the pectoralis major muscle flap improved repair range and distance in reconstruction of complex surgical defect following resection of head and neck malignancies. It also reduced necrosis rate of skin lfaps. Postoperative donor and recipient sites regained their appearance and functions successfully. The pectoralis major muscle lfap is one of the important tissue lfaps used in reconstruction of surgical defect following resection of a head and neck malignancy.
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During an educational dissection, accessory tendon of the biceps brachii muscle was found on the right side in a Korean cadaver. The short and long heads showed normal morphology and course: however, narrow tendon was originated from the posterior border of the pectoralis major muscle and was inserted into the conjoined tendon of the long head of the biceps brachii muscle. The authors describe this previously novel case report and discusses the clinical implications of such a variant.
Subject(s)
Cadaver , Head , TendonsABSTRACT
Occurrence of variant muscular slips from pectoralis major muscle is rare. In this report, we present a rare case of aberrant muscular slip associated with the pectoralis major muscle which we call costodorsalis. This muscular slip originated from the 6th rib near the costochondral junction and ran along the lower border of pectoralis major muscle. It crossed the axilla from medial to lateral side and merged with the latissimus dorsi muscle. This type of origin and insertion is unique and has not been reported earlier. The knowledge of this muscle variation may be of special importance to the anesthesiologists, physiotherapists and plastic surgeons.
Es poco frecuente la aparición de variaciones de un fascículo muscular desde el músculo pectoral mayor . En este trabajo, presentamos el caso de un fascículo muscular aberrante asociado con el músculo pectoral mayor que denominamos costodorsal. Este fascículo muscular se originó en la 6 costilla cerca de la unión costocondral y corrió a lo largo del margen inferior del músculo pectoral mayor. Cruzó la axila de medial a lateral y se fusionó con el músculo latísimo del dorso. Este tipo de origen y la inserción es único y no se ha informado anteriormente. El conocimiento de esta variación muscular puede ser de especial importancia para los anestesistas, fisioterapeutas y cirujanos plásticos.
Subject(s)
Humans , Male , Adult , Pectoralis Muscles/anatomy & histology , Anatomic Variation , Cadaver , DissectionABSTRACT
Interpostion arthroplasty with allograft has been known as a useful option for the shoulder arthropathy, but it has a limitation to immune response. We performed the pectoralis major muscle transfer for shoulder arthropathy. From January 2007 to December 2007, we performed the pectoralis major muscle transfer in 2 patients. They were 1 man and 1 woman, and the mean age of the patients was 70 years (range, 65 to 75). The average follow-up after surgery was 13 months (range, 12 to 14). We analyzed the clinical results by the American Shoulder and Elbow Surgeons (ASES) Score, and evaluated the pain by Visual Analogue Scale. The level of pain reduced from a preoperative average of 10 to a postoperative average of 1. The ASES scores increased from a preoperative mean of 9 to a postoperative mean of 58. These results indicated that interposition arthroplasty with the pectoralis major muscle transfer is a reliable treatment method for the shoulder arthropathy improving shoulder pain, and patient satisfaction.
Subject(s)
Female , Humans , Arthroplasty , Elbow , Follow-Up Studies , Muscles , Patient Satisfaction , Shoulder , Shoulder Pain , Transplantation, HomologousABSTRACT
PURPOSE: Poland syndrome is rare disease which is characterized by absence of unilateral pertoralis major muscle accompanied by ipsilateral syndactyly or brachydactyly, which was described first by Alfred Poland in 1841. MATERIALS AND METHODS: We performed the physical examination, laboratory test and radiologic evaluation to 18 year old male, who complaint asymmetry of right anterior chest. RESULTS: We diagnosed the Poland syndrome due to absence of right pectoralis major muscle and brachydactyly of right hand. CONCLUSION: Current authors report a patient who had hypopalsia of pectoralis muscles, which needed differential diagnosis with pectoralis major rupture.
Subject(s)
Humans , Male , Brachydactyly , Diagnosis, Differential , Hand , Muscles , Pectoralis Muscles , Physical Examination , Poland , Poland Syndrome , Rare Diseases , Rupture , Syndactyly , ThoraxABSTRACT
A unilateral anomalous disposition of the muscular slips of pectoralis major was observed in an adult male cadaver during routine gross anatomy teaching session. The pectoralis major muscle displayed unusual configuration and comprised of four parts delineated by three intramuscular clefts. Further, the sternocostal part was found to divide into two fasciculi. The origin and insertion of pectoralis major muscle was as usual and unremarkable. Interestingly, the innervation of the muscle was observed to bear an important variation. The clavicular and sternocostal slips of pectoralis major muscle received a direct branch from the lateral cord of brachial plexus in addition to its usual innervation from the lateral and medial pectoral nerves. The multiplicity of innervation of pectoralis major as encountered in the present study would presumably augment its suitability for its use in reconstructive procedures. An additional anomalous attachment of the pectoralis minor muscle was also observed emanating from the second rib, apart from the usual third, fourth and fifth ribs. These variants of the pectoral muscles may also have implications in biomechanical studies, as they may alter the kinematics.
Una disposición anómala unilateral de los vientres musculares del músculo pectoral mayor se observó en un cadáver adulto de sexo masculino durante una clase de rutina de anatomía. El músculo pectoral mayor mostró una configuración inusual y presentaba cuatro partes delimitadas por tres depresiones intramusculares. Además, la parte esternocostal se encontraba dividdida en dos fascículos. El origen y la inserción del músculo pectoral mayor era normal. Curiosamente, la inervación de los músculos, presentaba una importante variación anatómica. Los fascículos clavicular y esternocostal del músculo pectoral mayor recibieron una rama directa del fascículo lateral del plexo braquial, además de su inervación normal de los nervios pectoral lateral y medial. La múltiple inervación del músculo pectoral mayor como se encuentró en el presente estudio, probablemente, haga aumentar su idoneidad para el uso en procedimientos reconstructivos. También se observó un fascículo adjunto anómalo adicional del músculo pectoral menor, que se originaba de la segunda costilla, además de su origen en la tercera, cuarta y quinta costillas. Estas variaciones de los músculos pectorales también puede tener implicancias en estudios biomecánicos, ya que probablemente alteran la cinemática.
Subject(s)
Humans , Male , Adult , Pectoralis Muscles/abnormalities , Pectoralis Muscles/innervation , CadaverABSTRACT
During an educational dissection, the supernumerary head of the biceps brachii muscle was found on the left side in a Korean cadaver. The short and long heads were normal: however, the third head originated from the pectoralis major muscle and was inserted into the conjoined tendon of the biceps brachii muscle. The author describes this previously unreported case in Korea and discusses the clinical implications of such a variant.
Subject(s)
Cadaver , Head , Korea , Muscles , TendonsABSTRACT
Breast cancer is the second leading cause of death in woman. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. This paper introduces the breast reconstruction by use of pectoralis major muscle transfer with breast implant for small size defect after skin sparing mastectomy for more satisfaction. We reviewed 24 consecutive patients who underwent breast reconstruction by pectoralis major muscle transfer with implant and only breast implant in Dong-A University from April 2002 to March 2004. The patient's age ranged between 29 and 54 years with mean of 42.3 years. We used pectorals major muscle transfer with breast implant in 12 patients and breast implant alone in 12 patients as control. The follow-up period of patients ranged from 10 months to 3 years with mean of 18.5 months. The points of comparison with control group reconstructed by breast implant alone were doctor and patient satisfaction score, operation time, duration of admission, amount of drainage, complication and satisfaction according to mass location. In conclusion, there is no difference with control group in the point of operation time, mount of drainage, duration of admission. And there is higher level of doctor's and patient's satisfaction in group reconstructed by pectoralis major muscle transfer with breast implant than implant only group. Especially, pectoralis major muscle transfer with breast implant was especially necessary for the defect in upper lateral quadrant of the breast to get more satisfaction. The advantage of pectoralis major muscle transfer with breast implant is prevention of the protruding and palpability of implant and aesthetically satisfactory result by intraoperative modification of breast shape.