Fat grafting into the latissimus dorsi (LD) flap in a delayed manner due to asymmetry between the autologous LD breast and the contralateral breast. Under the rather scarred circumstances, fat is injected with a blunt cannula into the pectoralis major muscle, into the myocutaneous flap, into the subcutaneous layer and, above all, the very superficial subdermal layer. The videoclip illustrates the angles of approach and teaches the technique.

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 331-331
Author(s):  
Päivi A. Merkkola-von Schantz ◽  
M. Susanna C. Kauhanen
1982 ◽  
Vol 90 (1) ◽  
pp. 58-68 ◽  
Author(s):  
John Conley ◽  
Michael E. Sachs ◽  
Robert B. Parke

Rehabilitation of major resections of the tongue has always posed a serious problem. This paper presents the feasibility and rationale of rehabilitating partial glossectomies by the use of the pectoralis major myocutaneous flap and the fabrication of a “new tongue” by the use of this flap. The criteria for these techniques in benign and malignant tumors of the tongue are outlined. The segmental innervation of the pectoralis major muscle from a variety of three to five nerve branches permits the development of a skin-muscle flap that may be transposed with its nerve supply intact or totally denervated, depending upon the status of the hypoglossal nerves and tongue in the operative field. This presents the possibility of transposing a skin-muscle flap into a glossal wound with a completely intact nerve supply where the new flap is under constant instruction in its new physiologic environment. It also presents the possibility of neurotization of the denervated section of the muscle flap by axones from the intact segment of tongue. A third possibility is the fabrication of a “new tongue” by the transfer of the hypoglossal nerves into the denervated segment of the peripheral aspect of the myocutaneous flap. This variety and combination of rehabilitative techniques introduces a new phase into the rehabilitation of the tongue.


1993 ◽  
Vol 49 (2) ◽  
pp. 25-27
Author(s):  
Poobalam Gounden

This study was designed to. examine the effect of posture on forced expiration as reflected in phasic electromyographic activity in accessory expiratory muscles in tetraplegic subjects with complete lesions between the fifth and eight cervical segments. In order to determine the effect of posture on the action of the clavicular head of the pectoralis major muscle and the latissimus dorsi muscle during forced expiration, the subjects were studied in two test positions, support sitting and supine lying.Electromyographic examination of the above mentioned muscles in eight tetraplegic subjects showed changes in electrical activity in the clavicular portion of the pectoralis major muscle when the subjects were studied in the supine position. Four out of eight subjects showed evidence of an increase in EMG activity in the supine lying position. When the muscle was tested with the patient in the supported sitting position it failed to demonstrate a significant increase in electromyographic activity during forced expiration.We concluded therefore that the role of the clavicular portion of the pectoralis major muscle during expiration in tetraplegia is posture dependent. These findings have important therapeutic implications: specific training programmes to increase the strength and endurance of this muscle should be conducted with the subject in the correct position. The action of the latissimus dorsi muscle was not significantly influenced by the postural changes during forced expiration.


2020 ◽  
Vol 19 (2) ◽  
pp. 83-94
Author(s):  
Charilaos Ioannidis

Introduction: Poland syndrome is a rare congenital disorder. Its main characteristics are deficiency of the sternocostal portion of the pectoralis major muscle and symbrachydactyly. However, it encompasses a wide spectrum of other chest, breast and upper extremity anomalies. Patients and Methods: The author’s personal experience with a small series of patients with Poland syndrome is retrospectively reviewed. Only chest and breast anomalies were surgically corrected. A bilateral augmentation mammoplasty using different size implants was performed in order to restore chest and breast asymmetry in female patients. The latissimus dorsi muscle was transferred in order to replace the absent pectoralis major in male patients. Results: Eleven adult patients were found. There were 8 female and 3 male patients (age 21-29, mean 23,5y). Two patients refused any kind of treatment. Nine patients (six females, three males) underwent surgical correction (right side n=8, left side n=1). The follow-up period ranged from 6 months to 14 years. There were no major complications. There was a minor complication (seroma) in a male patient after latissimus dorsi transfer, which resolved spontaneously. No capsular contracture has been detected to date and no revision or implant change has been necessary in any of the female patients. All patients were satisfied with the final outcome. Conclusions: The pedicled latissimus dorsi muscle is still the “golden standard” for replacement of the totally absent pectoralis major muscle especially in males. Breast implants are highly successful in correcting chest/ breast asymmetry (size and shape anomalies) in females. Remaining nipple/areola deformities can be easily tackled at a later stage.


There is a remarkable fold in the tendon of the pectoralis major muscle, described by all anatomists, but the purpose of which has never yet, as the author believes, been explained. The muscle itself consists of two portions, one smaller and upper, arising from the cla­vicle, and passing downwards and outwards to an insertion in the humerus at a greater distance from the shoulder-joint than the place where the tendon of the larger and lower portion of the muscle, which arises from the sternum and ribs, and has a general direction upwards and outwards, terminates. Thus the respective portions of tendon belonging to the two divisions of the muscle are found to cross each other ; the margin of that proceeding from the lower division passing behind, and appearing above that which proceeds from the upper fibres of the muscle. The forces exerted by each portion of the muscle being thus applied to parts of the bone at different distances from the fulcrum, act with different mechanical powers ; which the author finds in every case to correspond exactly with the variations in the effects required to be produced, under different circumstances, by these mus­cular actions. Those muscular fibres, the tendon of which is inserted nearest to the centre of motion, and which consequently act by a shorter lever, are adapted to motions requiring a less force, but a greater velocity : and such is precisely the mechanical condition of the lower portion of the pectoralis major, which is employed more especially in bringing down the arm, when previously raised, as in striking with the hammer, pickaxe, &c., where velocity is chiefly re­quired, the weight of the instrument held in the hand sufficiently sup­plying the diminution of force. On the contrary, the lever by which the upper portion of the same muscle is enabled to act being, from the more distant insertion of its tendon, of greater length, is calcu­lated to procure force at the expense of velocity, and is therefore pe­culiarly fitted for the performance of those actions by which the arm is elevated and weights raised; these being precisely the actions in which such muscles are employed. Adverting, also, to the respective obliquities in the direction of their action, the author traces the same express correspondence between the mechanism employed and the purpose contemplated. He pursues the same line of argument and obtains the same results in extending the inquiry to the structure and uses of those muscles, such as the coraco-brachialis, and the anterior fibres of the deltoid, which cooperate with the upper division of the pectoralis major; and the teres major and latissimus dorsi, which combine their actions with that of the lower division of the pectoral muscle. This diversified adaptation of parts, he observes, forms the chief characteristic of the mechanism of Nature. Operating with unlimited means, she yet works with scrupulous economy; in all her structures no power is redundant, nor a single advantage lost: so that, how­ever completely an arrangement may be subservient to one primary purpose, we find, on renewed examination, an equally accurate ad­justment to various secondary and no less important ends.


2004 ◽  
Vol 118 (3) ◽  
pp. 221-222
Author(s):  
P. Chaturvedi

A variety of approaches have been employed for the reconstruction of head and neck defects and most of the techniques involve the use of arterialized vascular flaps alone, or in conjunction with other regional or local tissues. We frequently use a pectoralis major myocutaneous (PMMC) flap in our hospital in addition to other pedicled or free tissue transfers. A PMMC flap is a reliable flap with acceptable complications, needs a small learning curve, takes less time, and does not require additional investment (i.e. microscopes, loops etc). The disadvantages of the PMMC flap is that it has a restricted arc of rotation, gives a cosmetically unacceptable bulk in the neck, it is difficult in females and causes significant shoulder dysfunction. We have made a small improvization in the flap-raising technique which is helpful for the surgeon. This involves utilization of intestinal clamps to hold and cut the pectoralis major muscle.


2010 ◽  
Vol 2 (3) ◽  
pp. 253-255
Author(s):  
Chris de Souza ◽  
Pankaj Chaturvedi ◽  
Shriketan Kale

Abstract Patients undergoing salvage laryngectomy following chemoradiotherapy are more vulnerable to develop pharyngocutaneous fistula. This is due to fibrosis and reduced vascularity that results in poor postoperative healing. We are presenting a simple technique that can reduce this distressing complication. In patients where primary closure cannot be achieved, myocutaneous flap to reconstruct the pharynx reduces the incidence of postoperative complications. Similarly, buttressing of the suture line with the pectoralis major myofacial flap has been shown to reduce the fistula rates. Needless to say that pectoralis major muscle flap is a robust flap with acceptable complication rates.


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