Pectoralis major muscle injuries: evaluation and management

Pectoralis major muscle tears are relatively rare injuries that primarily occur while lifting weights, particularly when doing a bench press. Complete ruptures are most commonly avulsions at or near the humeral insertion. Ruptures at the musculo-tendinous junction and intramuscular tears usually are caused by a direct blow. The patient may hear a snap at the time of injury and report pain, weakness, swelling, or muscular deformity. Physical examination can reveal ecchymosis, a palpable defect, asymmetric webbing of the axillary fold, and weakness on resisted shoulder adduction and internal rotation. A detailed history and physical examination can be augmented by radiologic studies, including magnetic resonance imaging. Nonsurgical treatment is now recommended only for the older, sedentary patient or for proximal muscle belly tears. Surgery, whether early or delayed, consistently yields superior results compared with nonsurgical management. Prompt diagnosis and timely intervention likely will produce improved results.     

Pectoralis major muscle free flap in rat model

The rat pectoralis muscle can serve as a vascularized, innervated muscle flap model. The muscle, consisting of superficialis and profundus portions, is supplied by separate neurovascular systems. The vessels to pectoralis profundus (averaging 0.3 mm in diameter) can be taken in continuity with the axillary vessels (averaging 11 mm in diameter), which are used for transplantation. The profundus portion of muscle weighed an average of 1.8 g, and the average pedicle length was 0.9 cm. Nine of 11 transplanted muscles were viable, with intact circulation at 72 hours. An example of muscle transplantation for tissue defect coverage was attempted. The pectoralis profundus transplant was technically reliable, and the muscle bulk and contour could allow biochemical and functional studies. © 1994 Wiley-Liss, Inc.     

Pectoralis major muscle flaps for closure of sternal defects

Summary A reliable and simple technique involving the use of pectoralis major muscle flaps is described for the closure of sternal and costal cartilage defects caused by debridement for chronic osteomyelitis following median sternotomy. No bone grafts, omentum flaps or skin grafts have been needed in more than 20 patients.     

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.     

Pectoralis major muscle flap with amnion in oral cavity reconstruction

The pectoralis major myocutaneous flap provides an excellent method for reconstruction of oral cavity defects. This flap has been used since 1978. However, the flap is not without problems. The major problem that has been seen is necrosis of the cutaneous and subcutaneous aspects of the flap. However, in all such instances the muscular portion of the flap survived. This complication was found to occur more commonly in the elderly, diabetics, patients with peripheral vascular disease and patients with excessive adipose or breast tissue superimposed between the cutaneous and muscular components of the flap. In this study the technique of oral cavity reconstruction in the high risk patient group has been modified to avoid using the skin component of the pectoralis major myocutaneous flap. Instead, pectoralis major muscle covered with amnion is used for reconstructive purposes with rapid healing and with very satisfactory functional and cosmetic results.     

Pectoralis major muscle transposition for treatment of infected median sternotomy wounds

Median sternotomy, currently the standard incision in open heart procedures, is rarely complicated by wound infection, but when present, it is associated with a high morbidity and mortality. Adequate treatment can be provided by means of transposition of the pectoralis major muscle. After thorough sternal wound debridement the muscle, based on the thoraco-acromial pedicle, is transposed into the defect. From September 1986 until December 1992 14 patients (mean age 67 years) with sternal infection were treated using this technique. Mean hospital stay after operation was 23 days; mean follow-up was 24 months. In 10 patients (72%) a successful treatment, i.e. a permanently cured infection, was achieved. Three patients (21%) developed a recurrence; one of them died during follow-up as a consequence of cardiac failure, the other two underwent reoperation and healing occurred at a later stage. In one patient (who died of a unknown cause 2 months after muscle transposition) the result was classified as unknown. In conclusion, transposition of the pectoralis major muscle is an adequate treatment for severe sternal infections. In comparison with conservative methods, mortality and morbidity can be reduced and hospital stay can be shortened.     

大圆肌的应用解剖

目的：研究大圆肌的形态特点及务管神经蒂特点。方法：对４４侧固定尸体的大圆肌的肌腹、肌肉起止点以及血管神经蒂进行解剖与测量。结果：大圆肌肌腹上缘长１１￣１８ｃｍ,下缘长６￣８ｃｍ,肌性起点占６３．６％,半腱半肌性起点３６．４％,腱性止点７９．５％,半腱兰肌性止点２０．５％。血供来自旋肩胛动脉７２．０％,胸背动脉６．８％,肩胛下动脉２０．５％,血管蒂呈多级分支,自起地入肌点可分离长度２．１￣７．６ｃｍ     

Pectoralis major muscle flap for deep sternal wound infection in neonates

BACKGROUND: Deep sternotomy wound infections during the neonatal period, their management utilizing the pectoralis major muscle flap (PMF), and their follow-up are reported. METHODS: Seven hundred-twenty consecutive pediatric cardiac operations performed from 1995 to mid 1998 in 108 neonates and 612 infants are reviewed. Nine children (1.25%), 6 neonates and 3 infants, developed deep sternotomy wound infections and underwent PMF reconstruction. The 6 neonates are reviewed. Their follow-up includes growth and development reports, physical examination, and computerized tomographic scans of the chest. RESULTS: The incidence of sternal wound complications in our neonatal patients (5.5%, 6 of 108) was significantly higher than in the infantile group (0.5%, 3 of 612), (p = 0.0001, odds ratio = 11.94). Five neonates were treated with a unilateral, turnover PMF reconstruction. One patient was treated by a bilateral rotational PMF. All sternal wounds healed successfully, and all patients survived. In a follow-up period, ranging from 6 to 31 months (mean 16.5 months), the growth and development of all operated neonates was as expected for their age. There were no signs of chronic sternal infection in any of them. CONCLUSIONS: Early recognition of sternal wound complications should facilitate surgical treatment. Utilizing the PMF promotes rapid wound healing and preservation of life in these severely ill neonates, with minimal developmental problems.     

Pectoralis major muscle flaps for closure of the infected median sternotomy wound

A case of post-sternotomy mediastinitis due to methicillin-resistant Staphylococcus aureus after aortocoronary bypass procedure was treated with debridement, open clean packing, and delayed wound closure by the technique of pectoral muscle flap mobilization. The cosmetic and functional results were excellent. This technique seems to be a very effective method of treatment for the serious complication of deep sternal infection with mediastinitis after cardiac operation.     

Ankle arthroscopy: anatomical features

The site and functional significance of the anatomical structures surrounding the ankle joint plays a major role in the selection of arthroscopic portals.     

Pectoralis major tendon rupture: A biomechanical analysis of repair techniques

Rupture of the insertion of the pectoralis major muscle to the proximal humerus is becoming a common injury. Repair of these ruptures increases patient satisfaction, strength, and cosmesis, and shortens return to competitive sports. Several repair techniques have been described, but recently many surgeons are using suture anchors. The traditional repair technique uses transosseous sutures, but no study has biomechanically compared the strength of these two repair techniques in human cadavers. Twelve fresh‐frozen human shoulder specimens were dissected. The pectoralis major tendon insertion was cut from the bone and repaired using one of the two repair techniques: specimens were randomly assigned to transosseous trough with suture tied over bone versus four suture anchors. The fixation constructs were pulled to failure at 4 mm/s on a materials testing system. The mean ultimate failure load of the transosseous repairs was 611 N and the mean ultimate failure load of the suture anchor repair was 620 N. The mean stiffness of the transosseous repair was 32 and 28 N/mm for the suture anchor group. We found no statistically significant difference between these two repair techniques. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1783–1787, 2011     

Pectoralis major myocutaneous island flap revisited: A sentinel vessel simplifying dissection

Surgical extirpation of advanced cancers of the head and neck almost always requires extensive resections that invariably necessitate some sort of large flap for reconstruction. In recent years immediate one-stage reconstruction of large defects in the area of the tonsillar fossa and the pharynx have been facilitated by the development of myocutaneous flaps, especially the pectoralis major myocutaneous flap. With this flap, immediate one-step reconstruction at the time of the initial operation is accomplished. Myocutaneous flaps, however, require more skill and concentration in their elevation than do skin flaps in order to preserve the axial feeder vessel running along the underside of the muscle and supplying the all-important perforating vessels to the overlying muscles and skin. We have noticed a constant perforating vessel, approximately 2-cm long, coming off the pectoral branch of the thoracoacromial artery medial to the cephalic vein and 2 cm below the border of the clavicle. This pierces the substance of the overlying pectoralis major muscle and runs anteriorly into the subcutaneous fatty hypodermal layer. This vessel accurately localizes the position of the proximal portion of the pectoral branch of the thoracoacromial artery before elevation of the pectoralis major muscle has been started. The imaginary line joining this vessel and the island skin flap allows simplicity in elevation of the muscle pedicle and obviates fear of transecting the arterial supply to the skin island during the dissection. We have found the vessel to be present in 26 consecutive cases over the last 12 months. We present our findings of a sentinel vessel localizing the pectoral branch of the thoracoacromial artery as a guide in liberating the muscular paddle and axial artery in elevation of pectoralis major myocutaneous island flaps.     

Pectoralis major myocutaneous flap: analysis of complications in a VA population.

Forty-five cases of head and neck reconstruction with pectoralis major myocutaneous flaps (PMMF) between 1985 and 1990 were analyzed retrospectively for complications. Thirty-two cases were done at the VA Medical Center and 13 at Albany Medical Center, a private university hospital. Total complication rate was 58%. In the VA population, complication rate was 59% as compared to 54% at the Albany Medical Center, which appears statistically not significant. It has been suggested that VA populations tend to have poorer health and socioeconomic status and are more likely to have higher complication rates. This conjecture is not borne out by this study. Complications are described and compared.     

Pectoralis major rupture in elderly patients: a clinical study of 13 patients

The purpose of this study was to analyze and describe circumstances and clinical aspects of pectoralis major rupture in elderly patients compared with younger patients. Eleven patients were nursing home residents and two were community residents. All had severe pain with a large pectoral ecchymosis extending to the lateral chest wall and arm. Twelve patients experienced substantial blood loss (average, 2.3 g/dL hemoglobin), which resulted in hemodynamic decompensation in two of the patients, necessitating a blood transfusion. The most probable mechanism of injury was indirect, caused by a brisk tearing movement applied to stiff, atrophic muscle during commonly used nursing procedures for transferring, positioning, and dressing the patients. The authors suspect this injury to be more common than reported. Although surgical repair is not required in the elderly, a proper diagnosis is imperative because the injury has a severe clinical impact necessitating care and followup.