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Journal of Nippon Medical School =... 2018The congenital absence of the pectoralis muscle is usually a manifestation of Poland syndrome. However, a nonsyndromic congenital absence of this muscle is rare, and... (Review)
Review
The congenital absence of the pectoralis muscle is usually a manifestation of Poland syndrome. However, a nonsyndromic congenital absence of this muscle is rare, and such absences are usually partial and unilateral. A complete or bilateral absence is even rarer. Two young men presented to our outpatient clinic with incidentally noted unilateral flat chest walls. By chest computed tomography, they were diagnosed with a congenital unilateral absence of the pectoralis muscles. They did not show any functional disability of the arms. As the congenital absence of the pectoralis muscles is often associated with leukemia and genitourinary anomalies, it is advised that hematological testing and renal ultrasonography be performed, even in nonsyndromic cases.
Topics: Adolescent; Adult; Humans; Leukemia; Male; Pectoralis Muscles; Poland Syndrome; Radiography, Thoracic; Tomography, X-Ray Computed; Urogenital Abnormalities; Young Adult
PubMed: 30464140
DOI: 10.1272/jnms.JNMS.2018_85-39 -
Surgical and Radiologic Anatomy : SRA Oct 2022The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently...
PURPOSE
The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently piercing the costocoracoid membrane. Knowledge about the location, morphology, and variations of the TAT and its branches is of great surgical importance due to its frequent use in various reconstructive flaps.
METHODS
A retrospective study was conducted to establish anatomical variations, their prevalence, and morphometric data on TAT and its branches. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography were analyzed. A qualitative evaluation of each TAT was performed.
RESULTS
A total of 15 morphologically different TAT variants were initially established. The median length of the TAT was set at 7.74 mm (LQ 3.50; HQ 13.65). The median maximum diameter of the TAT was established at 4.19 mm (LQ 3.86; HQ 4.90). The median TAT ostial area was set to 13.97 mm (LQ 11.70; HQ 18.86). To create a heat map of the most frequent location of the TAT, measurements of the relating structures were made.
CONCLUSION
In this study, the morphology and variations of the branching pattern of the TAT were presented, proposing a new classification system based on the four most commonly prevalent types. The prevalence of each branch arising directly from the TAT was also analyzed. It is hoped that the results of the present anatomical analysis can help to minimize potential complications when performing plastic or reconstructive procedures associated with TAT.
Topics: Humans; Retrospective Studies; Surgical Flaps; Plastic Surgery Procedures; Pectoralis Muscles; Axillary Artery
PubMed: 36094609
DOI: 10.1007/s00276-022-03016-4 -
Poultry Science Nov 2019Recently, a certain number of broiler abattoirs located in different Countries around the World have signaled an emerging quality issue termed "gaping" because of the...
Recently, a certain number of broiler abattoirs located in different Countries around the World have signaled an emerging quality issue termed "gaping" because of the separation of the fiber bundles affecting the external portion of the bipinnate pectoralis minor muscle. Thus, after defining the criteria to classify the muscles as Normal (NORM), Moderate (MOD), or Severe (SEV) cases, the incidence of gaping under commercial conditions was assessed on a total of 8,600 P. minor obtained from broiler chickens belonging to 43 flocks during a 6-mo period. Then, a total of 180 P. minor were selected based on previously defined criteria to evaluate the main quality traits (pH, color, water-holding/-binding capacity and tenderness), proximate composition, water mobility, and thermal properties as well as metabolic profile through 1H-Nuclear Magnetic Resonance spectroscopy. The average incidence of gaping defect was found to be 16.8% (8.8 and 8.0% MOD and SEV cases, respectively). As for the main quality traits, a reduction in ultimate pH was observed as the severity of the gaping defect increased, with SEV muscles displaying significantly lower values in comparison with NORM (5.96 vs. 6.02; P < 0.01), while MOD showed intermediate values (5.99). Concurrently, if compared with their NORM counterpart, MOD and SEV exhibited higher lightness (53.6 and 54.2 vs. 51.8; P < 0.01) coupled with higher (P < 0.05) cooking losses and longer (P < 0.05) transversal relaxation time of extra-myofibrillar water fraction. Overall, no significant differences were found concerning proximate composition and thermal properties. With regard to the metabolic profile, a significantly lower (P < 0.001) glutamine concentration was found in MOD and SEV muscles that, concurrently, revealed significant (P < 0.05) variations in the metabolites involved in energy-generating pathways. Overall, these findings evidenced that the gaping defect affecting broilers' P. minor muscles have strong similarities with the pale-soft-exudative condition previously described in poultry and likely results from the biochemical processes taking place during the post-mortem conversion of muscle to meat.
Topics: Animals; Chickens; Female; Food Quality; Male; Meat; Pectoralis Muscles
PubMed: 31347671
DOI: 10.3382/ps/pez418 -
Journal of Anatomy Aug 2021The pectoralis major fiber regions contribute uniquely to the mobility and the stability of the shoulder complex. It is unknown how age and sex influence the stiffness... (Comparative Study)
Comparative Study
The pectoralis major fiber regions contribute uniquely to the mobility and the stability of the shoulder complex. It is unknown how age and sex influence the stiffness of these regions during volitional contractions, but this knowledge is critical to inform clinical interventions targeting the pectoralis major. The aim of the present study was to determine if the activation-dependent stiffness of the pectoralis major fiber regions differs between the sexes and if it is altered with age. Ultrasound shear wave elastography was used to acquire shear wave velocity from the clavicular and the sternocostal fiber regions of 48 healthy participants, including 24 younger (12 males, 12 females, mean ± SD age 25 ± 4.1 years) and 24 older adults (12 males, 12 females, 55 ± 3.6 years). Participants performed vertical adduction and horizontal flexion torques in neutral and 90° externally rotated shoulder positions, and one of the two shoulder abduction positions (60° and 90°) at varying torque magnitudes (passive, 15% and 30% of maximal voluntary contraction). Separate linear mixed-effects models were run for each fiber region and shoulder position to determine if the activation-dependent stiffness differed between the sexes and was altered in older adults. Age-related alterations in stiffness during volitional contractions were observed in both fiber regions and were dependent on the task. Alterations in activation-dependent stiffness due to age were more pronounced in females than males. Additionally, females had greater stiffness than males during volitional contractions in both fiber regions. The present findings provide the first line of evidence that the activation-dependent stiffness of the pectoralis major fiber regions is influenced by sex and changes with age.
Topics: Adult; Aging; Clavicle; Female; Humans; Male; Middle Aged; Pectoralis Muscles; Sex Characteristics; Sternocostal Joints; Young Adult
PubMed: 34009684
DOI: 10.1111/joa.13455 -
Anesthesiology Sep 2019Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.
METHODS
Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.
RESULTS
Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of -30.5 mg [-42.2, -18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by -4.7cm · h [-5.1, -4.2] or -1.2cm [-1.3, -1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.
CONCLUSIONS
We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.
Topics: Analgesia; Breast Neoplasms; Female; Humans; Nerve Block; Pain, Postoperative; Pectoralis Muscles
PubMed: 31408448
DOI: 10.1097/ALN.0000000000002822 -
Acta Otorhinolaryngologica Italica :... Oct 2014Countless disadvantages of the "old" pectoralis major have been listed while the amazing versatility of the free flap armamentarium gives the opportunity to suit the... (Review)
Review
Countless disadvantages of the "old" pectoralis major have been listed while the amazing versatility of the free flap armamentarium gives the opportunity to suit the defect deriving from virtually every ablative head and neck surgery with a tailored reconstruction. Nevertheless, pectoralis major is still the "workhorse" for head and neck reconstruction in developing countries thanks to its ease of harvest, and minimal requirements in term of instrumentation. Furthermore, even in facilities with a high volume of reconstructions by free flaps, a certain number of pectoralis major flaps is still raised every year. The history, present role and current indications of the most widely head and neck reconstructive procedure ever has been reviewed.
Topics: Adult; Aged; Aged, 80 and over; Female; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Male; Middle Aged; Pectoralis Muscles; Plastic Surgery Procedures
PubMed: 25709148
DOI: No ID Found -
European Annals of Otorhinolaryngology,... Jan 2022The pectoralis major flap (PMF) is one of the most used pedicled flaps for reconstructive surgery in head and neck. Basing on previous studies observing that a vascular...
The pectoralis major flap (PMF) is one of the most used pedicled flaps for reconstructive surgery in head and neck. Basing on previous studies observing that a vascular accident or pedicle ligation not always resulted in necrosis of free flaps, sometimes after a short critical period, we describe the possibility to perform the division of the PMF pedicle. The autonomization of PMF is based on the hypothesis that the flap, after a critical period, develops a neoangiogenesis at the free portion in the recipient site. It represents a possible choice in selected patients with relapse or second tumour of the oral floor and/or mobile tongue, who have been already treated with PMF reconstruction. We provide a step-by-step description of the autonomization and use of the modified PMF. Moreover, we reported advantages and pitfalls. The modified PMF represents a safe reconstructive choice for patients advised against a free flap or a second pedicled flap, with good surgical outcomes.
Topics: Free Tissue Flaps; Head and Neck Neoplasms; Humans; Neoplasm Recurrence, Local; Pectoralis Muscles; Plastic Surgery Procedures
PubMed: 33858786
DOI: 10.1016/j.anorl.2021.01.004 -
BMC Oral Health Apr 2021Microvascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in...
BACKGROUND
Microvascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in multimorbid elderly patients and after surgery or radiotherapy, which aggravate microsurgery. This study evaluates indications and outcome of the submental island flap (SMIF) and the pectoralis major myocutaneous flap (PMMF) as alternatives to the free radial forearm flap (RFF).
METHODS
This retrospective study included 134 patients who had undergone resection and reconstruction with SMIF, PMMF, or RFF at our department between 2005 and 2020. The level of comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). Primary outcome variables were flap success, complications, wound dehiscence, surgery duration, as well as time at the ICU and the ward (hospitalization). Chi-square tests, t-tests, and ANOVA were performed for statistics.
RESULTS
24 SMIFs, 52 RFFs, and 58 PMMFs were included in this study. The flap types did not significantly differ in terms of flap success, complications, and healing disorders. The SMIF presented a success rate of 95.8% and was significantly more often used in elderly patients (mean age = 70.2 years; p < 0.001) with increased comorbidities than the PMMF (p < 0.01) and RFF (p < 0.001). SMIF reconstruction reduced surgery duration (p < 0.001) and time at the ICU (p = 0.009) and the ward (p < 0.001) more than PMMF and RFF reconstructions. PMMF reconstruction was successful in 91.4% of patients and was more frequently used after head and neck surgery (p < 0.001) and radiotherapy (p < 0.001) than SMIF and RFF reconstructions. Patients undergoing PMMF reconstruction more frequently required segmental jaw resection and had presented with advanced tumor stages (both p < 0.001). Nicotine and alcohol abuse was more frequent in the RFF and PMMF groups (both p < 0.001) than in the SMIF group.
CONCLUSIONS
The pedicled SMIF represents a valuable reconstructive option for elderly patients with increased comorbidity because of the shorter duration of surgery and hospitalization. On the other hand, the PMMF serves as a solid backup solution after head and neck surgery or radiotherapy. The rates of flap success, complications, and healing disorders of both pedicled flaps are comparable to those of free flap reconstruction.
Topics: Aged; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Myocutaneous Flap; Pectoralis Muscles; Plastic Surgery Procedures; Retrospective Studies
PubMed: 33874923
DOI: 10.1186/s12903-021-01563-7 -
Journal of Medical Radiation Sciences Sep 2020To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the...
INTRODUCTION
To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the breast.
METHODS
A retrospective review of 2688 paired full-field digital mammography (FFDM) CC view mammograms of women attending BreastScreen NSW between August and October 2015 was undertaken. PMM visualisation and measurements of PMM width and length, compressed breast thickness, the posterior nipple line (PNL) and age were recorded. Statistical analysis was performed using descriptive and inferential statistics to investigate associations between key breast measurements, age and PMM visualisation.
RESULTS
PMM visualisation was reported in 10.4% of images unilaterally (one breast, left or right only), 14.1% bilaterally (both left and right breasts) and 24.5% overall (unilateral and bilateral combined). There was little or no correlations between PMM length or width and age, breast compressed thickness or PNL. Multiple logistic regression analysis found that up to 15% of the variance in visualisation of the PMM was accounted for by the predictors overall. While some predictors provided a statistically significant contribution to the model, the contribution was small and the odds ratio for all predictors approximated 1.
CONCLUSION
This research could not replicate the '30% rule', and visualisation of the PMM was determined not to be influenced by the variables investigated. The significance of the 'rule' itself must be challenged where the vast majority of images (70-85%) do not comply, and there is no requirement for repeat imaging if the 'rule' is not met. Further research should be undertaken to validate this study including analysis of diagnostic images for comparison.
Topics: Breast; Humans; Image Processing, Computer-Assisted; Mammography; Pectoralis Muscles; Practice Guidelines as Topic
PubMed: 32567806
DOI: 10.1002/jmrs.404 -
Academic Radiology Jan 2023To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care...
RATIONALE AND OBJECTIVES
To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission.
MATERIALS AND METHODS
For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height, and muscle gauge as PMI x muscle density.
RESULTS
Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001.
CONCLUSION
in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.
Topics: Male; Humans; Female; Adult; Middle Aged; Aged; Pectoralis Muscles; COVID-19; Prognosis; Tomography, X-Ray Computed; Retrospective Studies
PubMed: 35667979
DOI: 10.1016/j.acra.2022.05.003