J Reconstr Microsurg 2009; 25(4): 255-260
DOI: 10.1055/s-0028-1104558
© Thieme Medical Publishers

Transfer of the Superior Portion of the Pectoralis Major Flap for Restoration of Shoulder Abduction

Haodong Lin1 , Chunlin Hou1 , Zhen Xu1
  • 1Department of Orthopedic Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
05. Dezember 2008 (online)

ABSTRACT

Shoulder function is frequently impaired or lost following brachial plexus injuries. We introduce a novel method of restoring shoulder abduction by transferring the superior portion of the major flap of the pectoralis. Between March 1998 and June 2003, eight patients with insufficient abduction of the shoulder joint were treated with transfer of the superior portion of the pectoralis major flap. The mean follow-up period was 6 years. In all cases, shoulder mobility was improved. The mean increase in active abduction was from 6 degrees to 74 degrees. The mean forward flexion increased from 10 degrees to 75 degrees, and subluxation was abolished. All patients were satisfied with their improvement in function. Transfer of the superior portion of the pectoralis major flap is an easy and practicable method to restore abduction without serious complications. The patients achieved good stability and functionality of the shoulder.

REFERENCES

  • 1 Gilbert A, Brockman R, Carlioz H. Surgical treatment of brachial plexus birth palsy.  Clin Orthop Relat Res. 1991;  264 39-47
  • 2 Slooff A C. Obstetric brachial plexus lesions and their neurosurgical repair.  Microsurgery. 1995;  16 30-34
  • 3 Aziz W, Singer R M, Wolff T W. Transfer of the trapezius for flail shoulder after brachial plexus injury.  J Bone Joint Surg [Br]. 1990;  72 701-704
  • 4 Cofield R H, Briggs B T. Glenohumeral arthrodesis: operative and long-term functional results.  J Bone Joint Surg [Am]. 1979;  61 668-677
  • 5 Berger A, Brenner P. Secondary surgery following brachial plexus injuries.  Microsurgery. 1995;  16 43-47
  • 6 Saha A K. Surgery of the paralysed and flail shoulder.  Acta Orthop Scand. 1967;  Suppl 97 5-90
  • 7 Berger A, Becker M H. Brachial plexus surgery: our concept of the last twelve years.  Microsurgery. 1994;  15 760-767
  • 8 Berger A, Schaller E, Mailänder P. Brachial plexus injuries: an integrated treatment concept.  Ann Plast Surg. 1991;  26 70-76
  • 9 Chuang D C. Functioning free muscle transplantation for brachial plexus injury.  Clin Orthop Relat Res. 1995;  314 104-111
  • 10 Goldner J L. Strengthening of the partially paralyzed shoulder girdle by multiple muscle-tendon transfers.  Hand Clin. 1988;  4 323-336
  • 11 Harmon P H. Surgical reconstruction of the paralytic shoulder by multiple muscle transplantations.  J Bone Joint Surg [Am]. 1950;  32 583-595
  • 12 Narakas A O. Muscle transpositions in the shoulder and upper arm for sequelae of brachial plexus palsy.  Clin Neurol Neurosurg. 1993;  95 S89-S91
  • 13 Ariyan S. The pectoralis major myocutaneous flap: a versatile flap for reconstruction in the head and neck.  Plast Reconstr Surg. 1979;  63 73-81
  • 14 Ariyan S. Further experiences with the pectoralis major myocutaneous flap for the immediate repair of defects from excisions of head and neck cancers.  Plast Reconstr Surg. 1979;  64 605-612
  • 15 Tobin G R. Pectoralis major segmental anatomy and segmentally split pectoralis major flaps.  Plast Reconstr Surg. 1985;  75 814-824
  • 16 Morain W D, Colen L B, Hutchings J C. The segmental pectoralis major muscle flap: a function-preserving procedure.  Plast Reconstr Surg. 1985;  75 825-830
  • 17 Palmer J H, Batchelor A G. The functional pectoralis major musculocutaneous island flap in head and neck reconstruction.  Plast Reconstr Surg. 1990;  85 363-367
  • 18 Koh K S, Eom J S, Kirk I. Pectoralis major musculocutaneous flap in oropharyngeal reconstruction: revisited.  Plast Reconstr Surg. 2006;  118 1145-1149
  • 19 Tobin G R. Pectoralis major segmental anatomy and segmentally split pectoralis major flaps.  Plast Reconstr Surg. 1985;  75 814-824
  • 20 Corten E M, Schellekens P P, Bleys R L, Hage J J, Kon M. The segmental pectoralis major free flap: anatomical features of its vascular pedicle.  Ann Plast Surg. 2006;  56 82-86
  • 21 Corten E M, Schellekens P P, Oey P L, Hage J J, Kerst A, Kon M. Function of the clavicular part of the pectoralis major muscle after transplantation of its sternocostal part.  Ann Plast Surg. 2007;  58 392-396
  • 22 Corten E M, Schellekens P P, Bleys R L, Kon M. The nerve supply to the clavicular part of the pectoralis major muscle: an anatomical study and clinical application of the function-preserving pectoralis major island flap.  Plast Reconstr Surg. 2003;  112 969-975
  • 23 Shinohara H. Does the nerve supply to both the superficial and deep surfaces of pectoralis major imply two separated developmental origins?.  J Anat. 1996;  188 263-268
  • 24 Jennings G J, Keereweer S, Buijze G A. Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon.  J Shoulder Elbow Surg. 2007;  16 837-842
  • 25 Wilson J S, Yiacoumettis A M, O'Neill T. Some observations on 112 pectoralis major myocutaneous flaps.  Am J Surg. 1984;  147 273-279
  • 26 Palmer J H, Batchelor A G. The functional pectoralis major musculocutaneous island flap in head and neck reconstruction.  Plast Reconstr Surg. 1990;  85 363-367
  • 27 Williams P L. Gray's Anatomy. 38th ed. Edinburgh, Scotland; Churchill Livingstone 1995: 269-272
  • 28 Morain W D, Colen L B, Hutchings J C. The segmental pectoralis major muscle flap: a function-preserving procedure.  Plast Reconstr Surg. 1985;  75 825-830
  • 29 Hoffman G W, Elliott L F. The anatomy of the pectoral nerves and its significance to the general and plastic surgeon.  Ann Surg. 1987;  205 504-507
  • 30 Moosman D A. Anatomy of the pectoral nerves and their preservation in modified mastectomy.  Am J Surg. 1980;  139 883-886
  • 31 Reid C D, Taylor G I, Waterhouse N. The clavicular head of pectoralis major musculocutaneous free flap.  Br J Plast Surg. 1986;  39 57-65
  • 32 Romanes G J. Cunningham's Textbook of Anatomy. 12th ed. Oxford, UK; Oxford University Press 1981: 317-320

Chunlin HouM.D. 

Department of Orthopedic Surgery, Changzheng Hospital, The Second Military Medical University

Fengyang Road 415, Shanghai 200003, People's Republic of China

eMail: chunlin_hou@yahoo.com.cn