| Objective: The reports about anatomical study of pectoralis majorisland flap transfer are lack.With the development of functionalsurgery,more and more surgeons begin to attach importance to reducingside injury and protecting the shape and function of supply site during flaptransfer.The purpose of this study as follows:Investigate the anatomicalcharacteristics of the nerve supply to the clavicular part of the pectoralismajor muscle.Learn the anatomical relationship between the vascularpedicle of the flap and the nerve suppling to the clavicular part of thepectoralis major muscle.Searching a new and rational technique foravoiding the nerve injury and protecting the shape and function of supplysite effectively.Supply anatomical supports to take good use of the muscleflap for repairing the head ,face, neck and shoulder defects with reasoneffectively and conveniently. Methods: 1. Anatomy study:general and microanatomical techniques,select the30 Chinese human specimens randomly,60 sides in total.(1)Dissect theclavicular part of the pectoralis major muscle and the pectoralis major anddeltoid groove,observe and take record the characteristics.(2)Dissect thenerve supplying to the clavicular part and the thoracoacromial arteryemerged, observe and take record the nerve's anatomical characteristicsincluding origin and distribution.(3) Observe and take record the spatialrelationship between the nerve and the main vascular pedicle. 2.Select 6 Chinese specimens randomly for simulating operationalexperiment.3 methods are used to transfer the flap.The first is transfer theflap from the medial side of the vascular pedicle origin site and above theclavicle,the second is from the medial side of the origin of the vascularpedicle and below the clavicle,the last and new method is from the lateralside of the origin of the vascular pedicle and through the deltopectoralgroove above the clavicle.(1) Compare the efficient repairing area of threemethods and the efficient length of the vascular pedicles.(2) observe andtake record the transfer characteristics of three methods and the influencebetween the nerve and the vascular pedicle. 3. The data are dealed with SPSS 10.0 statistics software. Result: 1. Anatomy results (1) the muscle length of the clavicular part of thepectoralis major is 12.6±1.3cm,width and thickness of origonal site are5.8±0.8cm and 0.9±0.1cm,width and thickness of terminal site are4.8±0.2cm and 0.7±0.1cm.No nerve in deltopectoral groove,cephalic veinin the groove.(2)The embranchment of "1 branch type" and the firstembranchment of "2 or 3 branches type " are the nerves to supply theclavicular part of the pectoralis major.The nerve is origined from branchplexus and run posteriorly and inferiorly,pass below the clavicle to chestpart.The projection point of the nerve which intersect the clavicle duringpassing below the bone is recorded.The distance between projection pointand sternoclavicular joint is 6.28±0.73cm.(3) A separate nerve whichcomes from pectoralis lateral nerve innervated the clavicular and uppermedial sternocostal portions of the pectoralis major muscle. This nervearises craniomedial to the main vascular pedicle of the flap and divides intoseveral branches. These branches run in a fascia on the deep surface of thepectoralis major muscle, superficial to the origin and distal course of thevascular pedicle. 2.Simulating operational experiment (1) The efficient repairing areaand the efficient length of the vascular pedicles of transfering the flap fromthe medial side of the origin of the vascular pedicle and below the clavicleis larger than the other two methods,but the probability of side injury isincreased.(2) The efficient repairing area of transfering the flap from themedial side of the origin of the vascular pedicle and above the clavicle isinclined to medial area, no dominant difference about the efficient length ofthe vascular pedicle between the new method and the second method,butthe probability of side injury is increased too.(3) Transfer of the pectoralismajor island flap to the head...
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