Document Detail


Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I. Part I: surgical anatomy and vascular and nerve supply of the pectoralis major muscle as a basis for muscle transfer.
MedLine Citation:
PMID:  19308568     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: The anatomy and neurovascular supply of the pectoralis major muscle was studied in order to establish the safe and functional muscle transfer for the reconstruction of elbow flexion in patients with arthrogryposis multiplex congenita (AMC).
METHODS: Twenty pectoralis major muscles were dissected in 11 adult cadavers. The distribution of the motor end plates was studied in five pectoralis major muscles in foetuses by the detection of esterases.
RESULTS: The pectoralis major muscle consists of clavicular, manubrial, sternocostal, costal and abdominal parts. Each part has a distinct vascular and nerve supply. The motor nerves arise from the medial and lateral pectoral nerves. The motor end plates are localised in one zone in the clavicular and manubrial parts and in two oblique zones in the distal parts of the muscle. In 15 cases, each of the muscle parts were supplied by one nerve branch. In four cases, six nerves were distinguished and the clavicular part was supplied by two nerves. In one case, four nerves were found, with the clavicular and manubrial parts supplied by one common nerve. Three branches (13 cases) or two arterial branches (seven cases) supplied the muscle, arising from thoracoacromial and lateral thoracic arteries, respectively. The superior branch supplied the clavicular and manubrial parts, whereas the dominant pectoral branch supplied the manubrial, sternocostal and costal parts of the muscle. The inferior branch of the lateral thoracic artery supplied the abdominal part in 13 cases. In seven cases, the inferior branch failed and the abdominal part was supplied from the dominant branch.
CONCLUSION: This study presents guidelines for the transfer of the distal parts of the pectoralis major muscle for the reconstruction of elbow flexion. The sternocostal, costal and abdominal parts of the muscle can be released as a unit from the chest wall after dissection between the second and third rib and be transferred to the brachium. They are sufficiently supplied from the dominant pectoral branch of the thoracoacromial artery in all cases and inconstantly from the inferior branch of the lateral thoracic artery and from three motor nerves.
Authors:
Jiri Chomiak; Pavel Dungl
Related Documents :
18780028 - Posterior approach for double nerve transfer for restoration of shoulder function in up...
1194318 - Variations in the nerves of the thumb and index finger.
8345258 - The anatomical course of the palmar cutaneous branch of the median nerve, including a d...
2728848 - Anatomical anomaly of human digastric muscles.
24204948 - The vitamin d receptor agonist bxl-01-0029 as a potential new pharmacological tool for ...
20939088 - Sensory and motor stimulation thresholds of the ulnar nerve from electric and magnetic ...
Publication Detail:
Type:  Journal Article     Date:  2008-09-16
Journal Detail:
Title:  Journal of children's orthopaedics     Volume:  2     ISSN:  1863-2521     ISO Abbreviation:  J Child Orthop     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2009-03-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101313582     Medline TA:  J Child Orthop     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  357-64     Citation Subset:  -    
Affiliation:
1st Medical Faculty of Charles University Prague, Orthopaedic Hospital IPVZ, University Hospital Na Bulovce, Budinova 2, 18081, Prague 8, Czech Republic, jirichomiak@yahoo.com.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and inte...
Next Document:  Short-term experience with Ponseti casting and the Achilles tenotomy method for clubfeet treatment i...