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Setlock CA, Lulic-Kuryllo T, Leonardis JM, Kulik M, Lipps DB. Age and sex influence the activation-dependent stiffness of the pectoralis major. J Anat 2021; 239:479-488. [PMID: 34009684 PMCID: PMC8273609 DOI: 10.1111/joa.13455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/29/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Cheryl A Setlock
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Madison Kulik
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Clavicle Survival as a Free Bone Graft: A Case Report of Minor Modification Added to Pectoralis Major Flap. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.7755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Reconstruction of the surgically created defects in the head and neck regions is a crucial step in the patients’ treatment plan. Regarding the involved tissues, various flaps and grafts have been introduced in the literature. The pectoralis major myocutaneous flap (PMMF) is one of the most versatile flaps with many variations for providing more advantages. Also, when bone tissue is needed, it can be reconstructed via an osteomyocutaneous flap including rib, sternum, or clavicle. Case Presentation: In this article, a case of oral squamous cell carcinoma with the extension to facial structures and, then, reconstructed with PMMF was presented, in which a medial half of clavicle bone was resected and employed as a free bone graft. Conclusions: Sectioning clavicle not only increases the arc of rotation and mobility of the PMMF but also provides a new source of bone graft in the vicinity. Besides, the survival of the graft and integration with the native bone is noteworthy.
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The Effect of Diltiazem on Microcirculation of Trans-planted Tissue Flaps: Experimental Study on Rabbits. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zaid W, Schlieve T. The Early Effects of Coronavirus Disease-2019 on Head and Neck Oncology and Microvascular Reconstruction Practice: A National Survey of Oral and Maxillofacial Surgeons Enrolled in the Head and Neck Special Interest Group. J Oral Maxillofac Surg 2020; 78:1859-1868. [PMID: 32745533 PMCID: PMC7366104 DOI: 10.1016/j.joms.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The coronavirus disease-2019 (COVID-19) pandemic has affected healthcare systems across the nation. The purpose of this study is to gauge the early effects of the COVID-19 pandemic on head and neck oncology and reconstructive surgery (HNORS) practice and evaluate their practice patterns especially ones that might be impacted by COVID-19 and compare them to the current literature. METHODS This study is a cross-sectional study that surveyed fellowship-trained oral and maxillofacial surgeons in HNORS. This cohort of surgeons was contacted via a generated email list of surgeons enrolled in the American Association of Oral and Maxillofacial Surgeons pathology special interest group. An electronic survey contained 16 questions to assess the COVID-19 effect on HNORS practice and capture their practice patterns from mid-March to mid-April 2020. Statistical analysis was performed to analyze counts, percentages, and response rates. RESULTS We had a 60% response rate (39 of 64); 72% of our responders worked at academic institutions, 18% marked themselves as hybrid academic/private practice, and only 10% were considered hospital-based surgeons. Only 8% of the survey respondents were requested to pause head and neck cancer surgery, whereas 24% were requested to pause free flap surgery during the pandemic. Fifty-five percent agreed that the head and neck and reconstructive surgery should be conducted during a pandemic. Finally, 45% thought that two weeks was a reasonable delay for head and neck cancer cases, whereas 29% thought they should not be delayed for any amount of time. Regarding practice patterns, microvascular reconstruction was the favored method (100%). Respondents generally admitted patients to an intensive care unit postoperatively (92%) and were kept on a ventilator (53%). CONCLUSION The COVID-19 pandemic had a small impact on the surgical treatment of patients with head and neck oncology. Most HNORS surgeons are practicing in accordance with recently published literature.
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Affiliation(s)
- Waleed Zaid
- Associate Professor, Department of Oral and Maxillofacial Surgery, Site Director of Oral and Maxillofacial Surgery - Baton Rouge, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA.
| | - Thomas Schlieve
- Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Dallas, TXl, Residency Program Director, Division of Oral and Maxillofacial Surgery, Dallas, TX, Director of Oral and Maxillofacial Surgery, Parkland Memorial Hospital, Dallas, TX, Director of Oral and Maxillofacial Surgery, Texas Health Presbyterian- Dallas, Dallas, TX
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Quantifying differences in the material properties of the fiber regions of the pectoralis major using ultrasound shear wave elastography. J Biomech 2017; 63:41-46. [DOI: 10.1016/j.jbiomech.2017.07.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/27/2017] [Accepted: 07/29/2017] [Indexed: 01/15/2023]
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Patel K, Lyu DJH, Kademani D. Pectoralis Major Myocutaneous Flap. Oral Maxillofac Surg Clin North Am 2014; 26:421-6. [DOI: 10.1016/j.coms.2014.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ong HS, Ji T, Zhang CP. The pedicled latissimus dorsi myocutaneous flap in head and neck reconstruction. Oral Maxillofac Surg Clin North Am 2014; 26:427-34. [PMID: 24958381 DOI: 10.1016/j.coms.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The pedicled latissimus dorsi myocutaneous flap (PLDMF) is not the first-line reconstructive option for most clinicians; however, when treating salvage patients or those with depleted neck vessels, the PLDMF provides a valuable armamentarium. Unlike the pectoralis major myocutaneous flap or the lower island trapezius flap, the PLDMF has greater versatility in soft tissue design and a longer arc of rotation. These advantages are of great importance in managing advanced reconstructive cases.
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Affiliation(s)
- Hui Shan Ong
- Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Tong Ji
- Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Chen Ping Zhang
- Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China.
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Jena A, Patnayak R, Sharan R, Reddy SK, Manilal B, Rao LMC. Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction. J Oral Maxillofac Surg 2014; 72:222-31. [PMID: 23945513 DOI: 10.1016/j.joms.2013.06.205] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/04/2013] [Accepted: 06/05/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Although much has been mentioned in the literature worldwide regarding the outcome of pectoralis major myocutaneous flaps (PMMFs), hardly any studies are available that mention the outcome of PMMFs in female patients. It has been presumed that complication rates after PMMF reconstruction in female patients are higher because of the presence of more adipose tissue in the flap. The objective of this study was to analyze our data regarding the outcomes of PMMFs in female patients with oral cancer undergoing reconstruction after tumor ablation. MATERIALS AND METHODS In this retrospective study from January 2008 to May 2012, performed in a single institution in south India, we have analyzed our data on PMMFs in 140 female patients with oral cancer. The operative technique used was essentially the same as that described originally by Ariyan. However, to preserve the deltopectoral flap area, the incision was appropriately modified in a manner as described by Schuller. RESULTS The mean age of the patients was 52.36 years, with a range from 30 to 76 years. They presented mostly with ulcers or ulceroproliferative lesions. Most of the patients had a history of tobacco and betel nut chewing. All of them underwent composite resection and reconstruction with PMMF under general anesthesia. Of the patients, 30 (21.4%) had complications, comprising infection (8), superficial flap necrosis (11), combined wound infection and superficial flap necrosis (3), total flap failure (2), and orocutaneous fistula (6). CONCLUSIONS PMMF reconstruction is a reliable and cosmetically acceptable method of reconstruction in female patients for oral cavity defects after tumor ablation.
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Affiliation(s)
- Amitabh Jena
- Associate Professor, Department of Surgical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati, India.
| | - Rashmi Patnayak
- Assistant Professor, Department of Pathology, Sri Venketeswar Institute of Medical Sciences, Tirupati, India
| | - Rajeev Sharan
- Assistant Professor, Department of Surgical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati, India
| | - Siva Kumar Reddy
- Assistant Professor, Department of Surgical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati, India
| | - Banoth Manilal
- Assistant Professor, Department of Surgical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati, India
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Gadre KS, Gadre P, Sane VD, Halli R, Doshi P, Modi S. Pectoralis major myocutaneous flap--still a workhorse for maxillofacial reconstruction in developing countries. J Oral Maxillofac Surg 2013; 71:2005.e1-2005.e10. [PMID: 24135523 DOI: 10.1016/j.joms.2013.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/03/2013] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To retrospectively evaluate the utility of the pectoralis major myocutaneous (PMMC) flap for head, face, and neck (HFN) reconstruction in the Indian population. MATERIALS AND METHODS The hospital records of 496 patients in whom the PMMC flap was used (saving the deltopectoral flap) for reconstruction of HFN defects from January 1991 to December 2010 were reviewed retrospectively. All the patients were followed up for a minimum period of 6 months, and the utility of the PMMC flap was evaluated for HFN reconstruction. RESULTS Of the 496 patients, complications developed in 84 patients. The complications included complete flap failure in 12, partial skin paddle loss in 24, wound infection in 12, peripheral wound dehiscence in 16, plate exposure in 12, and donor site morbidity such as infection and a decrease in function in 8. CONCLUSIONS The PMMC flap or its modification was used in 496 cases of reconstruction after resection surgery for malignancy of the HFN region with minimal morbidity and 1 death. This technique is a useful alternative in places with a high incidence of HFN malignancies and microsurgical free tissue transfer is not possible or as a salvage procedure in selected large, full-thickness, oral cavity lesions. In our 19-year experience, the final functional and cosmetic results were satisfactory with this sturdy flap.
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Affiliation(s)
- Kiran Shrikrishna Gadre
- Consultant Maxillofacial Surgeon, Ruby Hall Clinic; Professor, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth University Dental College and Hospital, Katraj, Pune, Maharashtra, India
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Moumine M, Tahri R, Harroudi T, Benkabbou A, Elotmany A, Regragui A, Kanouni M, Mikou A, Gamra L, Thiery G. [A giant chondroblastic osteosarcoma of the mandible. A case report]. ANN CHIR PLAST ESTH 2011; 56:269-72. [PMID: 21689588 DOI: 10.1016/j.anplas.2009.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 11/13/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Osteosarcoma of the craniofacial bones location is less common, usually with low grade of malignancy; it has better prognosis when surgical excision is complete. REPORT CASE We report a case of a 35-year-old male diagnosed with a low-grade chondroblastic osteosarcoma of the mandible. The patient was treated with surgery alone and recovered with pectoralis major myocutaneous flap. After 48 months, the oncology's and aesthetics results are good. DISCUSSION We will discuss the treatment of chondroblastic osteosarcoma of the mandible.
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Affiliation(s)
- M Moumine
- Service de chirurgie I, institut national d'oncologie, Rabat, Maroc.
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Kruse AL, Luebbers HT, Obwegeser JA, Bredell M, Grätz KW. Evaluation of the pectoralis major flap for reconstructive head and neck surgery. HEAD & NECK ONCOLOGY 2011; 3:12. [PMID: 21352590 PMCID: PMC3056835 DOI: 10.1186/1758-3284-3-12] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/27/2011] [Indexed: 11/29/2022]
Abstract
Purpose The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. Patients and methods The records of all patients treated with a PMMF between 1998 and 2009 were systematically reviewed. Data of recipient localization, main indication, and postoperative complications were analyzed. Results The male to female ratio was 17:3, with a mean age of 60 years (45-85). Indications in 7 patients were recurrence of a squamous cell carcinoma, in one case an osteoradionecrosis and in 12 cases an untreated squamous cell carcinoma. In 6 male patients (30%), a complication appeared leading to another surgery. Conclusion The PMMF is a flap for huge defects in head and neck reconstructive surgery, in particular when a bulky flap is needed in order to cover the carotid artery or reconstructive surgery, but the complication rate should not be underestimated in particular after radiotherapy.
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Affiliation(s)
- Astrid L Kruse
- Department of Craniomaxillofacial and Oral Surgery, University of Zurich, Switzerland.
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Assessment of the Functionality of the Pectoralis Major Myocutaneous Flap Skin Paddle. J Craniofac Surg 2011; 22:365-70. [DOI: 10.1097/scs.0b013e3181f81634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sun G, Lu M, Tang E, Yang X, Wen J, Wang Z. Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects. ACTA ACUST UNITED AC 2010; 112:34-41. [PMID: 21195642 DOI: 10.1016/j.tripleo.2010.09.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 09/05/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the clinical features and therapeutic efficacy of the intraoral defects reconstruction with 3 types of anterolateral thigh flaps. STUDY DESIGN The clinicopathologic data of 39 cases with oral tumors were obtained from the School of Stomatology, Nanjing University Medical Center, from December 2008 to June 2010. These patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free anterolateral thigh flaps. RESULTS There were 22 male and 17 female patients; the ratio of male to female was 1.3:1; the mean age was 56.1 years. Twenty-two of the anterolateral thigh flaps were musculocutaneous flaps (56.4%), 8 were fasciocutaneous flaps (20.5%), and 9 were ultrathin flaps (23.1%). Five patients required operative exploration in the perioperative period. Three flaps were thrombotic events, 1 flap was hematoma, and 1 flap was twisting of perforator. After the salvages, 1 flap was partial failure, 1 flap was total failure, and the other 3 flaps were complete survival. CONCLUSIONS The free anterolateral thigh flap was the ideal soft tissue flap in the intraoral defects reconstruction. This flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.
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Affiliation(s)
- Guowen Sun
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Nanjing University Medical Center, Nanjing University, Stomatological Hospital of Nanjing, Nanjing, China.
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Avery C, Crank S, Neal C, Hayter J, Elton C. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010; 46:829-33. [DOI: 10.1016/j.oraloncology.2010.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 11/15/2022]
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