• Archives of Plastic Surgery
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• v.49 no.1
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• pp.39-42
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• 2022

Bilateral pectoralis major myocutaneous (PMMC) flaps are commonly used to reconstruct large chest wall defects. We report a case of large chest wall defect reconstruction using bilateral PMMC flaps augmented with axillary V-Y advancement rotation flaps for additional flap advancement. A 74-year-old male patient was operated on for recurrent glottic squamous cell carcinoma. Excision of the tumor resulted in a 10×10 cm defect in the anterior chest wall. Bilateral PMMC flaps were raised to cover the chest wall defect. For further flap advancement, V-Y rotation advancement flaps from both axillae were added to allow complete closure. All flaps survived completely, and postoperative shoulder abduction was not limited (100° on the right side and 92° on the left). Age-related skin redundancy in the axillae enabled the use of V-Y rotation advancement flaps without limitation of shoulder motion. Bilateral PMMC advancement flaps and the additional use of V-Y rotation advancement flaps from both axillae may be a useful reconstructive option for very large chest wall defects in older patients.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.113-115
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• 2006

The sternalis muscle is an uncommon variation in the anterior chest wall which is located superficial to the pectoralis major, coursing vertically almost parallel to the sternum. It exists unilaterally or bilaterally, as thin muscle strips or a broad band of muscles. We report two cases of skin sparing mastectomy and immediate breast reconstruction in which the sternalis muscle was encountered. This unusual variation might puzzle radiologists to mistake it for a tumor or an abnormal bulging of the pectoralis. Surgeons also must not be surprised to encounter this muscle during surgery of the breast or pectoralis and keep the appropriate dissection plane.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.60-62
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• 1981

The Poland`s syndrome is very rare anomaly, which consists of congenital unilateral absence of the sternocostal pert of the pectoralis major muscle, with ipsilateral hand deformities. The clinical features are variable but all patients have absence of at least the sternal head of the pectoralis major muscle. The syndrome is not hereditary and is of unknown origin. Early recognition of Poland`s syndrome may give the provision of psychological and genetic counseling for anxious parents. We have encountered a patient with this entity, who showed striking paradoxical movement of the left anterior Ghest wall and recurrent pneumonia, and underwent successful surgical correction.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.156-159
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• 2023

Breast implants whether used for cosmetic or reconstructive purposes can be placed in pockets either above or below the pectoralis major muscle, depending on clinical circumstances such as subcutaneous tissue volume, history of radiation, and patient preference. Likewise, cardiac implantable electronic devices (CIEDs) can be placed above or below the pectoralis major muscle. When a patient has both devices, knowledge of the pocket location is important for procedural planning and for durability of device placement and performance. Here, we report a patient who previously failed subcutaneous CIED placement due to incision manipulation with prior threatened device exposure requiring plane change to subpectoral pocket. Her course was complicated by submuscular migration of the CIED into her breast implant periprosthetic pocket. With subcutaneous plane change being inadvisable due to patient noncompliance, soft tissue support of subpectoral CIED placement with an acellular biologic matrix (ABM) was performed. Similar to soft tissue support used for breast implants, submuscular CIED neo-pocket creation with ABM was performed with durable CIED device positioning confirmed at 9 months postprocedure.

• Archives of Plastic Surgery
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• v.46 no.5
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• pp.486-487
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• 2019

• Korean Journal of Applied Biomechanics
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• v.14 no.1
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• pp.41-50
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• 2004

The objective of the study is to analyze the myoelectrical activity involved in performing the Swallow movement, a D-level technique, in order to use it as the basic research data in helping train gymnasts in how to perform strength-related techniques. To this end, four national representative athletes who participated in the 2002 Busan Asian Games were selected. The results of the comparison analysis of the individual models are summarized as follows. 1) The results of the E.M.G analysis showed that during the Swallow movement, the myoelectrical activity was detected higher in pectorialis major muscle and bicep brachii muscle than in trapezius muscle and deltoid muscle. 2) The results of the E.M.G analysis showed that during the Swallow movement, the myoelectrical activity was measured high in triceps brachii muscle and palmaris longus muscle, while the myoelectrical activity was recorded low in latissimus dorsi muscle and rectus abdominis muscle. 3) In performing the Swallow in the rings, the mean average (%) was found high in the order of erector spinae, pectorialis major muscle, palmaris longus muscle, triceps brachii muscle, deltoid muscle, latissimus dorsi muscle, and trapezius muscle. All taken together, the athletes showed a difference in the distribution of the muscles during the performance of the Swallow. The muscle that showed a constant distribution among the athletes was pectoralis major muscle, which proves that for a stable performance, it is ideal to increase the myoelectrical activity in pectoralis major muscle.

• Korean Journal of Head & Neck Oncology
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• v.11 no.1
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• pp.47-55
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• 1995

A large lateral facial defects especially a through and through defect of the cheek remains as challenging field of reconstruction for the head and neck surgeons. Closure of these wounds is technically troublesome due to the magnitude and location of the soft tissue and skin defect, functional and aesthetic consideration. optimal cancer surveillance, and desire for good nourishment. Most traditional methods dealing with these defects, including split-thickness skin graft, local and regional flaps as well as musculocutaneous flaps have their limitations. We applied four different methods for these reconstruction in four cases. We utilized temporal muscle flap, forearm free flap and secondary healing for repair of mucosal defects, and medial base cervicopectoral flap, pectoralis major myocutaneous flap and cervicofacial flap for the reconstruction of external skin defects. In one case, both sides were reconstructed with single forearm free flap. In our experiences, secondary healing could be one of the useful method for mucosal repair in the defect between upper and lower gingivobuccal sulcus. However, forearm free flap was thought to be more ideal for the cases with mandibulectomy. For the external repair, the regional skin flap was considered to be superior to pectoralis major myocutaneous flap or forearm free flap especially on color matching.

• The Journal of Korean Physical Therapy
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• v.28 no.2
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• pp.106-111
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• 2016

Purpose: The aim of this study is to determine the effect of glenohumeral (GH) rotation position in modified knee push-up plus exercise (MKPUP) by examining the surface electromyography (EMG) amplitude in serratus anterior (SA), pectoralis major (PM), and upper trapezius (UTz) and the activity ratio of each muscle. Methods: A total of 22 healthy subjects volunteered for the study. Each subject performed the MKPUP at $0^{\circ}$, $45^{\circ}$, and $90^{\circ}$ of GH joint internal rotation. EMG of the SA and PM, UTz was compared between GH rotation positions and each muscle activity ratio. EMG was used to measure the muscle activity in terms of ratios to maximal voluntary isometric contraction (MVIC). Results: The difference in EMG activity during the exercise in three GH joint internal rotation positions was observed with the SA and the PM. The greater the GH joint internal rotation angle was, the lower the activity of the PM. In contrast, the SA showed higher activity. However, the activity of UT was similar under all conditions. The ratio of the SA and the PM was considerably greater at $90^{\circ}$ GH joint internal rotation than at $0^{\circ}$ and $45^{\circ}$. Conclusion: When excessive activation of the PM or imbalanced activation between the PM and the SA occurs, the MKPUP exercise is most effective at $90^{\circ}$ of GH joint internal rotation. Use of this position would be a beneficial strategy for selective strengthening of the SA and minimizing PM activation.

• The Transactions of The Korean Institute of Electrical Engineers
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• v.65 no.4
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• pp.678-683
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• 2016

The study aim was to investigate a comparison of muscle activity fatigue between maximal and submaximal strength gains during the bench press in men. It was hypothesized that maximal voluntary contraction (%MVC) would similar gains between maximal and submaximal strength gains during the bench press, but median frequency (MDF) would increase in maximal compared with submaximal exercise. Employing a randomized, counterbalanced crossover design, 12 men were asked to perform maximal repetitions and submaximal repetitions (concentric: 1-s, eccentric: 1-s, 2-s/repetition) to failure with a load of 85% of 1RM for the bench press, with a 3-minute recovery between the sets. Each subject was tested for the number of repetitions and sets, total work in bench press. Surface electromyography (EMG) was recorded from the pectoralis major, deltoid anterior, and triceps brachii for %MVC and MDF. Total work was significantly higher in the submaximal repetition exercise than that the maximal repetition exercise (p<.05). Muscle fatigue of pectoralis major, deltoid anterior and triceps brachii were significantly smaller in the submaximnal repetition exercise than that the maximal repetition exercise (p<.05, respectively). However, muscle activity of pectoralis major, deltoid anterior, and triceps brachii were not significantly different between exercises. Our study showed that a smaller muscle fatigue in submaximal repetitions, despite higher in total work and a similar in muscle activity were observed. These results suggest that submaximal repetitions during the bench press would be enhanced intensity and/or volume compared with maximal repetitions exercise.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.643-648
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• 2012

Background Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. Methods Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. Results All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past $90^{\circ}$. Internal and external rotation were not affected. Conclusions We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.