Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1735417 ◽

2021 ◽

Author(s):

Pallab Chatterjee ◽

Anuj Kumar Sharma ◽

Pranay Pratap ◽

Ajay Dabas ◽

Bharat Mishra ◽

...

Keyword(s):

Observational Study ◽

Pectoralis Major Muscle ◽

Pectoralis Major ◽

M 10 ◽

Electrical Devices ◽

Total Muscle

Abstract Introduction Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence. Aim To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study. Material and Methods Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension. Results Twelve patients (m = 10; f = 2) with a mean age of 65 years (range, 46–82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8–30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality. Conclusion In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.

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Partial monopolar transfer of pectoralis major for elbow active flexion restoration in children with arthrogryposis

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors79241 ◽

2021 ◽

Vol 9 (4) ◽

pp. 407-416

Author(s):

Olga E. Agranovich ◽

Ekaterina V. Petrova ◽

Sergey F. Batkin ◽

Evgeniya I. Ermolovich ◽

Igor A. Komolkin ◽

...

Keyword(s):

Biceps Brachii ◽

Pectoralis Major Muscle ◽

Elbow Flexion ◽

Pectoralis Major ◽

Software Packages ◽

Active Flexion ◽

Before And After ◽

The Mean ◽

Elbow Motion

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii. AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle. MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11. RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 31.72) postoperative. The mean age of patients was 6.24 4.24 years. The active postoperative elbow motion was 0120 (71.94 33.40). The passive postoperative elbow motion did not change and was 90130 (104.12 12.40). Muscles strength after the operation was grade 25. Elbow extension was limited in 30 cases (76.9%) from 0 to 40 (21.70 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%). CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.

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Commentary on: Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up

Aesthetic Surgery Journal ◽

10.1093/asj/sjw170 ◽

2016 ◽

Vol 36 (10) ◽

pp. 1122-1123

Author(s):

Allen Gabriel ◽

G. Patrick Maxwell

Keyword(s):

Chest Wall ◽

Pectoralis Major Muscle ◽

Pectoralis Major ◽

Vertical Mammaplasty

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Return to Sport and Exercise Following Repair of the Pectoralis Major Tendon

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00252 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0025

Author(s):

Joseph Liu ◽

Anirudh K. Gowd ◽

Grant Hoerig Garcia ◽

Brandon J. Manderle ◽

Alexander K. Beletsky ◽

...

Keyword(s):

Bench Press ◽

Pectoralis Major Muscle ◽

Return To Sport ◽

Pectoralis Major ◽

History Of Surgery ◽

History Of ◽

Sport And Exercise ◽

Injury Status ◽

Dominant Side

Objectives: Outcomes following repair of the pectoralis major muscle (PMM) is often prone to the ceiling effect due to the high functional demand of those that sustain this injury. A thorough evaluation of return to exercise and sport is beneficial to set patient expectations. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients undergoing PMM repair since 2010 with minimum 24-month follow-up. Patients were surveyed over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell bench press, dumbbell bench press, dumbbell fly, and consecutive push-ups. American shoulder and elbow (ASES) and single assessment numeric evaluation (SANE) scores were also collected preoperatively and at final follow-up. Results: Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 and mean BMI was 28.6 ± 3.5. The dominant side was affected in 20/44 cases. The injury mechanism was reported to be during weightlifting in 59.1%, during sport in 20.5%, during work in 13.6%, and during accidental trauma in 6.8% of patients. There were statistically significant improvements in both ASES and SANE (p<0.001, respectively). Return to sport at any level was achieved by 43/44 (97.7%) patients, while 22/44 patients (50.0%) reported returning to sport at same or better intensity as pre-injury status. On average, there was a 23.3 ± 45.6% decrease in 1RM barbell bench press, 14.7 ± 62.3% decrease in 5RM barbell bench press, 24.3 ± 21.8% decrease in 1RM dumbbell bench press, 35.7 ± 32.1% decrease in 1RM dumbbell fly, and 15.6 ± 39.8% decrease in consecutive push-ups able to be performed (Figure 1). Seventeen patients (38.6%) reported degree of apprehension that affected their ability to lift weights. When accounting for all preoperative variables, history of surgery to the opposite shoulder (OR: 0.600, 95% CI: 0.389, 0.925) and acute repairs (OR: 0.745, 95% CI: 0.559, 0.993) were associated with decreased likelihood to return to sport at same or better level of intensity. Injury sustained during sport was associated with greater likelihood of returning to sport at same or better level (OR: 2.231, 95% CI: 0.389, 0.925) (Table 1). Conclusion: Patients undergoing repair of the PMM are expected to have significant improvements in function of the shoulder. Yet, roughly 50% achieve return to preoperative intensity of sport and there are significant reductions in ability to weightlift. Patients should be counseled to appropriately set expectation prior to surgery and rehabilitation. [Figure: see text][Table: see text]

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Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up

Aesthetic Surgery Journal ◽

10.1093/asj/sjw114 ◽

2016 ◽

Vol 36 (10) ◽

pp. 1113-1121 ◽

Cited By ~ 14

Author(s):

Ruth Graf ◽

André Ricardo Dall Oglio Tolazzi ◽

Priscilla Balbinot ◽

André Pazio ◽

Pedro Miguel Valente ◽

...

Keyword(s):

Chest Wall ◽

Pectoralis Major Muscle ◽

Pectoralis Major ◽

Vertical Mammaplasty

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Partial Tears of the Pectoralis Major Muscle

Visnyk Ortopedii Travmatologii Protezuvannia ◽

10.37647/0132-2486-2020-107-4-12-20 ◽

2020 ◽

pp. 12-20

Author(s):

S.S. Strafun ◽

V.V. Haiovych ◽

Yu.A. Kulyk ◽

V.H. Lieskov

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Subjective Evaluation ◽

Pectoralis Major Muscle ◽

Pectoralis Major ◽

Conservative Group ◽

Partial Tear ◽

Number Of Patients ◽

Partial Tears

Summary. Partial tear of the pectoralis major muscle (PMM) is an extremely rare injury, but it needs to be studied. Objective: to carry out a comparative analysis of the clinic, diagnosis and treatment of patients with complete and partial tears of the PMM. Materials and Methods. A retrospective analysis of 9 patients with partial tears of the PMM who underwent surgical and conservative treatment at the Department of Microsurgery and Reconstructive Surgery of Upper Extremity of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” (Kyiv) from 2008 to 2018 was performed. The mean age of patients with partial tear of the PMM was 37.4±10.8 years (16 to 42 years); 8 were males and 1 was female. The follow-up period after surgical or conservative treatment was 12±2.8 months. The greatest number of injuries occurred during the bench press exercises – 55.6% (5 patients); on the uneven bars – 22.2% (2 patients) and in everyday life – 22.2% (2 patients). Results. Follow-up examination revealed that 55.6% (5 patients) had injuries of tendon-muscle transition IIC, 33.3% (3 patients) – of tendon part II D, and 11.1% (1 patient) – of muscle II B according to the Cordasco 2020 classification. All the patients deny taking steroids to increase muscle mass. Surgical treatment was performed within 10-643 days after the injury. Two operated on patients had acute injuries (up to 8 weeks after the trauma), and 3 had chronic injuries (more than 8 weeks after the trauma). The results on both the Quick DASH scale and the Subjective Evaluation of Patients with Pectoralis Major Muscle Injuries Questionnaire were negative in both groups during initial treatment. One year after the treatment, excellent and good results were observed in the operated on group; the conservative group showed unsatisfactory results. We did not note any complications after surgical interventions in operated on group of patients. Conclusions. Partial tears of the PMM require more careful differentiation and additional examination methods. Physically active patients with isolated tears of the PMM need surgical treatment. Such treatment gives excellent and good results, while conservative treatment – unsatisfactory. Due to the small number of patients in our study, partial PMM tears require further investigation.

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