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Wolfram S, Lipps DB. The in vivo passive stretch response of the pectoralis major is region-specific. J Biomech 2023; 161:111856. [PMID: 37939425 DOI: 10.1016/j.jbiomech.2023.111856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
The pectoralis major (PM) is a broad muscle commonly divided into three regions, which contribute uniquely to shoulder stability and movement. The PM muscle regions likely respond differently to stretch, but this has never been shown in vivo. We used shear wave elastography to assess the stretch response of different PM muscle regions during shoulder abduction and external rotation in 20 healthy male participants. Participants' shoulder was passively rotated through their range of motion in 5.7° increments and shear wave velocities (SWV) were obtained for each muscle region. A piece-wise model was fitted to the SWV-joint angle data, from which slack angle, slack stiffness and elasticity coefficient were determined. For shoulder abduction, we found that the sternocostal region had a significantly smaller slack angle (p = 0.049) and greater slack stiffness (p = 0.005) than the abdominal region, but there was no difference for elasticity coefficient (p = 0.074). For external rotation, only slack stiffness was greater for the sternocostal than the abdominal region (p < 0.001) with no differences found for slack angle (p = 0.18) and elasticity coefficient (p = 0.74). However, our data indicates that neither region was slack in this condition. These findings indicate that the sternocostal and abdominal regions respond differently to passive stretch, highlighting the PM's functional differentiation. This differentiation should be considered during treatment interventions such as PM muscle harvesting or treatments for breast cancer.
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Affiliation(s)
- Susann Wolfram
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, United States; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, United States.
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Miyawaki Y, Sato H, Yokogawa H, Sakuramoto S, Okamoto K, Yamaguchi S, Koyama I. Superdrainage Using the Cephalic Vein Due to Unsuitable Internal Thoracic Vein for Microvascular Anastomosis in Esophageal Reconstruction Using Pedicled Jejunum. Ann Thorac Cardiovasc Surg 2021; 27:322-326. [PMID: 31092745 PMCID: PMC8560539 DOI: 10.5761/atcs.cr.19-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
The progress and popularization of microvascular surgical techniques may improve the outcomes of esophageal reconstruction using non-gastric tube (GT) grafts. A pedicled jejunum (PJ) with microvascular anastomoses is frequently selected as a reconstructed conduit for esophageal reconstruction when the GT is unavailable, and the internal thoracic (IT) vein is frequently selected as a recipient blood vessel for microvascular anastomosis. However, the IT vein may be inadequate for microvascular anastomosis because of its absence or underdevelopment. Since it is difficult to preoperatively predict such rare cases, it becomes necessary to urgently and rapidly prepare an alternative blood vessel. Herein, we present surgical procedures for superdrainage using the cephalic vein (CeV). Due the superficial nature of the CeV, it is both easy to identify and collect sufficient length. Thus, the CeV is very useful as an urgent substitute blood vessel when the IT vein is unavailable for microvascular anastomosis in esophageal reconstruction.
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Affiliation(s)
- Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hideki Yokogawa
- Department of Plastic and Reconstructive Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Morita D, Nemoto H, Miyamoto M, Miyabe K, Togo T, Kobayashi S. Reconstruction of a Pharyngeal Cutaneous Fistula Using a Bi-Paddled Pectoralis Major Flap for a Patient with a Possibility of Future Postoperative Radiotherapy. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926689. [PMID: 33144555 PMCID: PMC7649745 DOI: 10.12659/ajcr.926689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pharyngocutaneous fistulas are often difficult to treat because pharyngeal contents tend to leak into the cervical layer causing wound infections or abscesses. If reconstruction with free flaps is difficult, pedicled pectoralis major flaps are an option. CASE REPORT A 51-year-old male patient who had undergone radiation and chemotherapy for laryngeal cancer was scheduled for total laryngectomy with combined skin resection for local tumor recurrence. Reconstruction with a left deltopectoral (DP) flap was performed. However, a pharyngocutaneous fistula constructed due to cervical soft-tissue infection required reconstruction using a right bi-paddled pectoralis major muscle. The anterior pharyngeal wall was reconstructed with the medial skin island, and the lateral skin island was folded back to reconstruct the soft tissues. Since this was the patient's third recurrence, the possibility of subsequent local recurrences, and hence of the need for radiation therapy, were high. In such cases, the pedicle of the pectoralis major muscle flap is normally closed using a DP flap. However, in the present case, the DP flap had already been used on both sides. We therefore utilized a right bi-paddled pectoralis major flap for cervical reconstruction. CONCLUSIONS We successfully reconstructed the cervical skin and soft tissue thickly, and primarily-closed the donor site, by creating a second skin island from surplus areas of the existing skin island. This method is particularly useful for the reconstruction of cervical skin and soft tissues due to the possible need for future radiation therapy, when the use of free flaps and DP flap is unfeasible.
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Affiliation(s)
- Daiki Morita
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.,Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Nemoto
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.,Department of Plastic and Reconstructive Surgery, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Masaru Miyamoto
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kenta Miyabe
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tomoichiro Togo
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Sei Kobayashi
- Department of Otolaryngology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Esmonde N, Rodan W, Haisley KR, Joslyn N, Carboy J, Hunter JG, Schipper PH, Tieu BH, Hansen J, Dolan JP. Treatment protocol for secondary esophageal reconstruction using 'supercharged' colon interposition flaps. Dis Esophagus 2020; 33:5810256. [PMID: 32193534 DOI: 10.1093/dote/doaa008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022]
Abstract
Locoregional esophageal cancer is currently treated with induction chemoradiotherapy, followed by esophagectomy with reconstruction, using a gastric conduit. In cases of conduit failure, patients are temporized with a cervical esophagostomy and enteral nutrition until gastrointestinal continuity can be established. At our institution, we favor reconstruction, using a colon interposition with a 'supercharged' accessory vascular pedicle. Consequently, we sought to examine our technique and outcomes for esophageal reconstruction, using this approach. We performed a retrospective review of all patients who underwent esophagectomy at our center between 2008 and 2018. We identified those patients who had a failed gastric conduit and underwent secondary reconstruction. Patient demographics, perioperative details, and clinical outcomes were analyzed after our clinical care pathway was used to manage and prepare patients for a second major reconstructive surgery. Three hundred and eighty eight patients underwent esophagectomy and reconstruction with a gastric conduit. Seven patients (1.8%) suffered gastric conduit loss and underwent a secondary reconstruction using a colon interposition with a 'supercharged' vascular pedicle. Mean age was 70.1 (±7.3) years, and six patients were male. The transverse colon was used in four cases (57.1%), left colon in two cases (28.6%), and right colon in one case (14.3%). There were no deaths or loss of the colon interposition at follow-up. Three patients (42.9%) developed an anastomotic leak, which resolved with conservative management. All patients had resumption of oral intake within 30 days. Utilizing a 'supercharging' technique for colon interposition may improve the perfusion to the organ and may decrease morbidity. Secondary reconstruction should occur when the patient's oncologic, physiologic, and psychosocial condition is optimized. Our outcomes and preoperative strategies may provide guidance for those centers treating this complicated patient population.
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Affiliation(s)
- N Esmonde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - W Rodan
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - K R Haisley
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - N Joslyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J Carboy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J G Hunter
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - P H Schipper
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - B H Tieu
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J Hansen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J P Dolan
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
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Haładaj R, Wysiadecki G, Clarke E, Polguj M, Topol M. Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6212039. [PMID: 31061824 PMCID: PMC6466946 DOI: 10.1155/2019/6212039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. Rare cases of muscular anomalies involving the PM or its tendon have been presented. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. MATERIAL AND METHODS The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. RESULTS Typical PM structure was observed in 63.75% of specimens. The most frequently observed variation was a separate clavicular portion of the PM. In one female cadaver (2.5% of specimens) the hypotrophy of the clavicular portion of the PM was noticed. In two male cadavers (5% of specimens) the fusion between the clavicular portion of the PM and the deltoid muscle was observed. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihler's stain. PM is mainly innervated by the lateral pectoral nerve. In all specimens stained by Sihler's technique, the contribution of the intercostal nerves in PM innervation was confirmed. CONCLUSIONS Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region.
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Affiliation(s)
- Robert Haładaj
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Edward Clarke
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
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Liu J, Zhang X, Zhen Q, Su Y, Han Z, Chen G. Esophageal reconstruction: Combined application of muscle tissue flap and inner chitosan tube stent in rabbits. Technol Health Care 2017; 24 Suppl 2:S505-12. [PMID: 27163311 DOI: 10.3233/thc-161175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Esophageal reconstruction is the key issue in esophageal surgery. However, currently there is no satisfied technique to repair esophagus after surgery. OBJECTIVE To combine an inner chitosan stent and a muscle tissue with vascular pedicle to repair the esophageal defect in cervical segment. METHODS Esophageal defect was repaired using the combination of a muscle tissue flap and a chitosan tube stent in experimental group while only muscle tissue flap was utilized in controls for comparison. One animal in each group was sacrificed at week 3, 6 and 9 after operation respectively to exam the healing status. Barium X-ray was used to evaluate the esophageal status in 12 weeks. RESULTS Histology showed the inflammatory response in 3 weeks after surgery, the chitosan stent was partially absorbed in 6 weeks, and there was no obvious fibrotic proliferation in experimental group; while the fibrotic proliferation and esophageal stenosis were obvious in controls, the chitosan stent was completely absorbed in 9 weeks, and squamous epidermis cells were observed. Twelve weeks later, the barium swallow went smoothly through the esophagus with noticeable peristalsis in the experimental group; esophageal stenosis without peristalsis was observed in controls. CONCLUSION The combination of chitosan stent and muscle tissue flap is feasible to reconstruct a partial defect in esophagus.
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Sacak B, Orfaniotis G, Nicoli F, Liu EW, Ciudad P, Chen SH, Chen HC. Back-up procedures following complicated gastric pull-up procedure for esophageal reconstruction: Salvage with intestinal flaps. Microsurgery 2015; 36:567-572. [PMID: 26679742 DOI: 10.1002/micr.22520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/30/2015] [Accepted: 09/29/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric pull-up (GPU) is the most common procedure for restoring the continuity of the alimentary tract. Yet, complications because of anastomotic problems are reported to be as high as 25% after this procedure. Managing the neck with anastomotic leakage or stricture following failed GPU and/or radiotherapy is formidable. We report our method, basic algorithm and results with the complicated GPU procedure management with intestinal transfers . PATIENTS AND METHODS Nineteen cases referred to our department with complicated esophageal reconstruction following GPU procedure were included in this report. Of the19 patients, 18 had undergone GPU procedure for reconstruction after cancer resection (mean age 55 years) and one for idiopathic esophagitis (mean age 45years). Fifteen patients presented with severe stricture formation and 4 patients with leakage from the anastomotic site. Average time between the GPU and salvage procedures was 7.3 months for patients with stricture formation and 15.5 days for patients with leakage. Pedicled colon interposition (n = 8) was used when the upper end of the gastric tube was located below the sternoclavicular junction. A free jejunal flap (n = 11) was utilized when defects were located at the neck (above the sternoclavicular junction). RESULTS In all patients salvage procedures with intestinal flap transfer were successful with complete flap survival. Post-operative period was uneventful except of two patients with pedicled colon interposition who presented minor leakage post-operatively (10.5%). This was treated with conservative means, leading to spontaneous healing. The average follow-up for the patients with tumor resection was 11.8 months (range: 6 to 30) after the salvage procedure. All patients resumed smooth oral intake eventually. There were 16 patients who could feed with solid diet, whereas three patients were able to tolerate only soft diet. CONCLUSION Intestinal tissues can be safely and successfully transferred as salvage procedures, with meticulous technique, careful patient selection and individual flap design. While gastric pull-up remains a good procedure for esophageal reconstruction, the methods described in this report are useful as back-up armaments in complicated cases. © 2015 Wiley Periodicals, Inc. Microsurgery 36:567-572, 2016.
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Affiliation(s)
- Bulent Sacak
- Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine, Istanbul, Turkey.,Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, London, UK
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - En-Wei Liu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Heng Chen
- Department of Plastic Surgery, Chang-Gung Memorial Hospital, Taipei, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
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Zelken JA, Kang CJ, Huang SF, Liao CT, Tsao CK. Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps. Microsurgery 2015; 37:112-118. [DOI: 10.1002/micr.22432] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Jonathan A. Zelken
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Taipei Taiwan
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Wiwanitkit V. Comments on "combined use of the cephalic vein and the skin graft-covered pectoralis major muscle for secondary thoracic esophageal reconstruction". Microsurgery 2014; 34:672. [PMID: 24962164 DOI: 10.1002/micr.22287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/28/2014] [Accepted: 06/13/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Viroj Wiwanitkit
- Hainan Medical University, China; Faculty of Medicine, University of Nis, Serbia; Joseph Ayobabalola University, Nigeria
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