OBJECTIVE: It is common to get lost during a comminuted proximal humerus surgery, and the pectoralis major insertion is always a constant. Therefore, this study aimed to do a cadaveric study on the Filipino population to assess the distance from the pectoralis major tendon to the top of the humeral head (PMT) as a reference during proximal humerus surgery. METHODS: This study dissected the shoulders of cadavers. The distance from the pectoralis major tendon insertion to the top of the humeral head (PMT) was measured using a caliper. This PMT distance was also correlated to the cadaver's height and sex. RESULTS: This study dissected 110 shoulders (55 cadavers | 24 females, 31 males). The median PMT was 5.40 cm for males and 4.90 cm for females, with a combined value of 5.40 cm overall. There was a direct and moderate correlation between the PMT with overall height. Height and PMT of both the left and right shoulder were significantly longer among males compared to females. The study showed that for every centimeter increase in the height of males, there was a corresponding 0.02 cm increase in the PMT, adding the constant factor of 1.83. A corresponding 0.04 cm increase in the PMT for females added the constant factor of -0.81. CONCLUSION; The pectoralis major tendon insertion is a consistent landmark that can accurately restore humeral length when reconstructing complex proximal humerus fractures where landmarks are otherwise lost because of comminution.
Pectoralis Muscles ; Humerus ; Tendons ; Fractures, Bone

We report the case of a patient who presented with rupture of a silicone breast implant showing acute and chronic inflammation. Magnetic resonance imaging (MRI) showed silicone foci outside the implant shell and inside the pectoralis muscles that represented intra- and extracapsular ruptures of the implant and silicone granuloma. There were distinct fluid-fluid levels of various signal intensities and no signs of implant collapse such as ‘linguine sign.’ Rather, we detected enlargement of both the implant shell and the breast.
Breast Implants ; Breast ; Granuloma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Pectoralis Muscles ; Rupture ; Silicon ; Silicone Elastomers ; Silicones

PURPOSE: The purpose of this study was to evaluate the ultrasonographic (US) features of traumatic neuromas in breast cancer patients after mastectomy. METHODS: This study was performed with approval from our Institutional Review Board, and the requirement for informed consent was waived. Six traumatic neuromas in five patients were included in this study. The US findings of traumatic neuromas were evaluated retrospectively by two radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The final assessment was also recorded. RESULTS: On US, all six lesions presented as a mass within the pectoralis muscle layer (mean size, 4.8 mm; range, 3.9 to 5.5 mm). Of the six masses, four had an oval shape with a circumscribed margin, and two had an irregular shape and an indistinct margin. They were all hypoechoic. Two lesions showed a non-parallel orientation. On color Doppler examinations, two lesions showed internal vascularity. Strain elastography was performed for four neuromas, resulting in scores of 1 (n=1), 4 (n=2), and 5 (n=1). The final assessment categories were BI-RADS 3 (n=2), 4A (n=2), and 4B (n=2). CONCLUSION: On US, an oval shape, circumscribed margin, parallel orientation, and hypoechogenicity were the most frequent features of traumatic neuromas in breast cancer patients after mastectomy. Neuromas may show increased vascularity on color Doppler imaging and present as a hard mass on elastography.
Breast Neoplasms* ; Breast* ; Elasticity Imaging Techniques ; Ethics Committees, Research ; Humans ; Information Systems ; Informed Consent ; Mastectomy* ; Neuroma* ; Pectoralis Muscles ; Retrospective Studies

BACKGROUND: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. METHODS: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. RESULTS: Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. CONCLUSION: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.
Diaphragm ; Dyspnea ; Follow-Up Studies ; Fractures, Bone ; Humans ; Lung ; Pectoralis Muscles* ; Propensity Score ; Sternum ; Thoracic Wall* ; Thorax* ; Vital Capacity ; Wounds and Injuries*

No abstract available.
Female ; Humans ; Pectoralis Muscles/*diagnostic imaging ; Trigger Points/*diagnostic imaging ; Ultrasonography

Subcutaneous implantation of a cardiac implantable electronic device is the standard method. Occasionally, subpectoral cardiac implantable electronic device (CIED) implantation via axillary incisions is performed in young female patients for cosmetic purposes. Because subpectoral CIED implantation and augmentation mammoplasty involve the same layer, it is feasible to perform both procedures simultaneously. We report a case of combined subpectoral implantation of an implantable cardioverter-defibrillator and augmentation mammoplasty via the axillary approach in a young female patient with dilated cardiomyopathy and small breasts.
Breast ; Cardiomyopathy, Dilated ; Defibrillators, Implantable* ; Female ; Female* ; Humans ; Mammaplasty* ; Methods ; Pectoralis Muscles ; Young Adult

BACKGROUND AND OBJECTIVES: Pectoralis major flap is the most versatile and reliable flap in the head and neck reconstruction. Owing to the recent development of microsurgical techniques, free flap reconstruction is gaining its popularity as a primary option for the reconstruction of head and neck defects. However, pectoralis major flap is a useful workhorse for the wide variety of situations including heavily irradiated neck, failure of prior reconstruction, and poor recipient vascular status. This study aimed to review our experience of pectoralis major flap surgery and to evaluate its clinical usefulness. SUBJECTS AND METHOD: We reviewed medical records of 113 patients (130 cases) who underwent pectoralis major flap surgery from 1995 to 2014. Indications and complications of pectoralis major flap surgery were evaluated. Association between complication rates and clinical factors were analyzed. RESULTS: Reconstruction of primary surgical defect was the most common indication (n=81/130, 62.3%). Complications developed in 17 cases (13.1%). Flap failure was observed in 2 cases (1.5%). The length of flap pedicle was closely related with complication rate (p=0.01). However, other factors including flap size, types of flap, radiation history did not influence complication rate. CONCLUSION: Pectoralis major flap is still a very useful option with a relatively low risk of complication for the head and neck reconstruction even in the era of frequent free flap surgery and heavy irradiation.
Free Tissue Flaps ; Head* ; Humans ; Medical Records ; Neck* ; Pectoralis Muscles ; Postoperative Complications ; Reconstructive Surgical Procedures ; Surgical Flaps

OBJECTIVETo investigate the application of combining mastopexy and triple-plane breast augmentation in correction of breast ptosis and atrophy.

METHODSPeri-areolar incision was performed to finish the fascia and dermal suspension to correct the breast ptosis. The implant was inserted under the pectoralis major muscle through lateral lower border of the gland and a "X" shape full thickness incision was made on the pectoralis major muscle according to the new position of nipple-areolar complex.

RESULTS14 patients received combined mastopexy and triple-plane breast augmentation to correct breast atrophy and mastopexy simultaneously. All the patients were regularly followed for 6-12 months. No patients suffered severe complication and the results were satisfied.

CONCLUSIONS"Triple-plane" breast augmentation could be safely performed with peri-areolar mastopexy with minor injury. The technique could help to ensure the balance between the gland, nipple-areolar complex and the implant.

Atrophy ; surgery ; Breast ; pathology ; surgery ; Breast Implantation ; methods ; Female ; Humans ; Mammaplasty ; methods ; Nipples ; pathology ; surgery ; Pectoralis Muscles ; surgery

OBJECTIVETo analyze and summarize the clinical features and experience in surgical treatment of deep sternal infection (DSWI).

METHODSThis was a retrospective study. From January 2008 to December 2013, 189 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department. There were 116 male and 73 female patients. The mean age was (54 ± 21) years, the body mass index was (26. 1 ± 1. 3) kg/m2. The incidence of postoperation DSWI were after isolated coronary artery bypass grafting (CABG) in 93 patients, after other heart surgery plus CABG in 13 patients, after valve surgery in 47 patients, after thoracic aortic surgery in 16 patients, after congenital heart disease in 18 patients, and after cardiac injury in 2 patients. Clean patients' wound and extract secretions, clear the infection thoroughly by surgery and select antibiotics based on susceptibility results, and then repair the wound with appropriate muscle flap, place drain tube with negative pressure. Of all the 189 patients, 184 used isolate pectoralis, 1 used isolate rectus, and 4 used pectoralis plus rectus.

RESULTSThe operative wounds of 179 patients were primary healing (94. 7%). Hospital discharge was postponed by 1 week for 7 patients, due to subcutaneous wound infection. Subcutaneous wound infection occurred again in 8 patients 1 week after hospital discharge, and their wounds healed after wound dressing. Nine patients (4. 7%) did not recover, due to residue of the sequestrum and costal chondritis, whom were later cured by undergoing a second treatment of debridement and pectoralis major muscle flap transposition. Eight patients died, in which 2 died of respiratory failure, 2 died of bacterial endocarditis with septicemia, 2 died of renal failure, 1 died of intraoperative bleeding leading to brain death and the 1 died of heart failure. The mortality rate was 4. 2% . The average length of postoperative hospital stay was (14 ± 5) days. The longest postoperative follow-up period was 40 months, the median time was 26 months, the follow-up rate was 83. 9% . Totally 179 patients were no-reinfected, 2 patients were reinfected because of artificial vascular rejection.

CONCLUSIONTo perform surgical debridement and then reconstruct the sternal defect with pectoralis major muscle flap actively for the patient is an effective measure to improve patient's survival rate.

Adult ; Aged ; Cardiac Surgical Procedures ; adverse effects ; Coronary Artery Bypass ; Debridement ; Female ; Heart Defects, Congenital ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Pectoralis Muscles ; transplantation ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Sternum ; surgery ; Surgical Flaps ; Surgical Wound Infection ; surgery ; Wound Healing

OBJECTIVETo evaluate the therapeutic effect of pedicled muscular flaps combined with partial thoracotomy for treatment of pythorax-resulted wounds and defects.

METHODS35 cases with pythorax-resulted refractory infected wound and dead space, were retrospectively analyzed. The wound and dead space were eliminated with pedicled muscular flaps, including latissimus dorsi muscular flaps and serratus anterior muscle flaps in 21 patients, pectoralis major muscle flaps with rectus muscle flaps in 8 patients, latissimus dorsi muscul flaps and vertical rectus muscle flaps in other 6 patients.

RESULTS34 flaps survived completely except for 1 verticle rectus muscular flap with partial necrosis at distal end. Primary healing was achieved in 29 cases. The other 6 cases were discharged with drainage. Among the 6 cases, 3 cases healed spontaneously, 2 cases underwent reoperation, 1 case need long-term drainage in the fistula.

CONCLUSIONPedicled muscular flap, combined with partial thoracotomy can effectively treat refractory wound and dead space resulted by pythorax.

Combined Modality Therapy ; methods ; Empyema, Pleural ; surgery ; Humans ; Myocutaneous Flap ; transplantation ; Pectoralis Muscles ; transplantation ; Reoperation ; Retrospective Studies ; Superficial Back Muscles ; transplantation ; Thoracotomy ; methods ; Wound Healing