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Shukun Shen - One of the best experts on this subject based on the ideXlab platform.
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extending the arc of rotation of the pectoralis major myocutaneous flap for orofacial reconstruction via a modified subclavicular route through the Clavipectoral Fascia
Journal of Oral and Maxillofacial Surgery, 2017Co-Authors: Liqun Xu, Shukun ShenAbstract:Purpose Drawbacks of the conventional supraclavicular overlay of the pectoralis major myocutaneous flap (PMMF) include the resultant unesthetic cervical bulge and the limited cephalad extension that limits its use to mandibular or cervical defects. This study discusses the technique and comparative advantages of a more esthetic subclavicular route through the Clavipectoral Fascia that allows an increased arc of rotation to reconstruct orofacial defects. Materials and Methods Patients with orofacial defects that were reconstructed with a PMMF through the modified subclavicular route were included in this retrospective cohort study, which aimed to compare the gain in extension accorded through the modified subclavicular tunnel over an initial conventional supraclavicular overlay. Outcome variables included the dimension of each skin paddle and the cross-sectional area of each flap. Other variables, such as age and gender, also were investigated. Complications that arose from this technique were statistically compared with these variables and with those from previously reported studies. All data analyses were performed using Pearson χ2 and correlation tests. Results Twelve patients (7 women and 5 men) who underwent a primary reconstruction with the PMMF during a 1-year period from November 2010 to November 2011 were selected for this study. All 12 flaps survived; 3 developed minor postoperative complications that resolved within the 3-month review period. A PMMF with an average dimension of 12.75 × 6.0 × 3.725 cm and cross-sectional area of 20.65 cm2 could pass through this modified tunnel, achieving an average gain in extension of 3.2 cm that enabled the reconstruction of defects up to and above the level of the oral commissure. Apart from skin paddle dimension, all other variables were not found to be statistically related to the extension accorded by the modified route. Complications that occurred appeared to be related only to the cross-sectional area of the flap. Conclusion The increased cephalad extension afforded by this modified subclavicular route through the Clavipectoral Fascia permitted the reconstruction of orofacial defects that would otherwise have required free vascularized grafts with microvascular surgery and avoided the unesthetic cervical bulge from conventional supraclavicular overlays of the PMMF.
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Extending the Arc of Rotation of the Pectoralis Major Myocutaneous Flap for Orofacial Reconstruction via a Modified Subclavicular Route Through the Clavipectoral Fascia.
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2016Co-Authors: Liqun Xu, Shukun ShenAbstract:Drawbacks of the conventional supraclavicular overlay of the pectoralis major myocutaneous flap (PMMF) include the resultant unesthetic cervical bulge and the limited cephalad extension that limits its use to mandibular or cervical defects. This study discusses the technique and comparative advantages of a more esthetic subclavicular route through the Clavipectoral Fascia that allows an increased arc of rotation to reconstruct orofacial defects. Patients with orofacial defects that were reconstructed with a PMMF through the modified subclavicular route were included in this retrospective cohort study, which aimed to compare the gain in extension accorded through the modified subclavicular tunnel over an initial conventional supraclavicular overlay. Outcome variables included the dimension of each skin paddle and the cross-sectional area of each flap. Other variables, such as age and gender, also were investigated. Complications that arose from this technique were statistically compared with these variables and with those from previously reported studies. All data analyses were performed using Pearson χ2 and correlation tests. Twelve patients (7 women and 5 men) who underwent a primary reconstruction with the PMMF during a 1-year period from November 2010 to November 2011 were selected for this study. All 12 flaps survived; 3 developed minor postoperative complications that resolved within the 3-month review period. A PMMF with an average dimension of 12.75 × 6.0 × 3.725 cm and cross-sectional area of 20.65 cm2 could pass through this modified tunnel, achieving an average gain in extension of 3.2 cm that enabled the reconstruction of defects up to and above the level of the oral commissure. Apart from skin paddle dimension, all other variables were not found to be statistically related to the extension accorded by the modified route. Complications that occurred appeared to be related only to the cross-sectional area of the flap. The increased cephalad extension afforded by this modified subclavicular route through the Clavipectoral Fascia permitted the reconstruction of orofacial defects that would otherwise have required free vascularized grafts with microvascular surgery and avoided the unesthetic cervical bulge from conventional supraclavicular overlays of the PMMF. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Liqun Xu - One of the best experts on this subject based on the ideXlab platform.
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extending the arc of rotation of the pectoralis major myocutaneous flap for orofacial reconstruction via a modified subclavicular route through the Clavipectoral Fascia
Journal of Oral and Maxillofacial Surgery, 2017Co-Authors: Liqun Xu, Shukun ShenAbstract:Purpose Drawbacks of the conventional supraclavicular overlay of the pectoralis major myocutaneous flap (PMMF) include the resultant unesthetic cervical bulge and the limited cephalad extension that limits its use to mandibular or cervical defects. This study discusses the technique and comparative advantages of a more esthetic subclavicular route through the Clavipectoral Fascia that allows an increased arc of rotation to reconstruct orofacial defects. Materials and Methods Patients with orofacial defects that were reconstructed with a PMMF through the modified subclavicular route were included in this retrospective cohort study, which aimed to compare the gain in extension accorded through the modified subclavicular tunnel over an initial conventional supraclavicular overlay. Outcome variables included the dimension of each skin paddle and the cross-sectional area of each flap. Other variables, such as age and gender, also were investigated. Complications that arose from this technique were statistically compared with these variables and with those from previously reported studies. All data analyses were performed using Pearson χ2 and correlation tests. Results Twelve patients (7 women and 5 men) who underwent a primary reconstruction with the PMMF during a 1-year period from November 2010 to November 2011 were selected for this study. All 12 flaps survived; 3 developed minor postoperative complications that resolved within the 3-month review period. A PMMF with an average dimension of 12.75 × 6.0 × 3.725 cm and cross-sectional area of 20.65 cm2 could pass through this modified tunnel, achieving an average gain in extension of 3.2 cm that enabled the reconstruction of defects up to and above the level of the oral commissure. Apart from skin paddle dimension, all other variables were not found to be statistically related to the extension accorded by the modified route. Complications that occurred appeared to be related only to the cross-sectional area of the flap. Conclusion The increased cephalad extension afforded by this modified subclavicular route through the Clavipectoral Fascia permitted the reconstruction of orofacial defects that would otherwise have required free vascularized grafts with microvascular surgery and avoided the unesthetic cervical bulge from conventional supraclavicular overlays of the PMMF.
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Extending the Arc of Rotation of the Pectoralis Major Myocutaneous Flap for Orofacial Reconstruction via a Modified Subclavicular Route Through the Clavipectoral Fascia.
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2016Co-Authors: Liqun Xu, Shukun ShenAbstract:Drawbacks of the conventional supraclavicular overlay of the pectoralis major myocutaneous flap (PMMF) include the resultant unesthetic cervical bulge and the limited cephalad extension that limits its use to mandibular or cervical defects. This study discusses the technique and comparative advantages of a more esthetic subclavicular route through the Clavipectoral Fascia that allows an increased arc of rotation to reconstruct orofacial defects. Patients with orofacial defects that were reconstructed with a PMMF through the modified subclavicular route were included in this retrospective cohort study, which aimed to compare the gain in extension accorded through the modified subclavicular tunnel over an initial conventional supraclavicular overlay. Outcome variables included the dimension of each skin paddle and the cross-sectional area of each flap. Other variables, such as age and gender, also were investigated. Complications that arose from this technique were statistically compared with these variables and with those from previously reported studies. All data analyses were performed using Pearson χ2 and correlation tests. Twelve patients (7 women and 5 men) who underwent a primary reconstruction with the PMMF during a 1-year period from November 2010 to November 2011 were selected for this study. All 12 flaps survived; 3 developed minor postoperative complications that resolved within the 3-month review period. A PMMF with an average dimension of 12.75 × 6.0 × 3.725 cm and cross-sectional area of 20.65 cm2 could pass through this modified tunnel, achieving an average gain in extension of 3.2 cm that enabled the reconstruction of defects up to and above the level of the oral commissure. Apart from skin paddle dimension, all other variables were not found to be statistically related to the extension accorded by the modified route. Complications that occurred appeared to be related only to the cross-sectional area of the flap. The increased cephalad extension afforded by this modified subclavicular route through the Clavipectoral Fascia permitted the reconstruction of orofacial defects that would otherwise have required free vascularized grafts with microvascular surgery and avoided the unesthetic cervical bulge from conventional supraclavicular overlays of the PMMF. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Russell F Warren - One of the best experts on this subject based on the ideXlab platform.
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Supporting layers of the glenohumeral joint. An anatomic study.
Clinical Orthopaedics and Related Research, 1993Co-Authors: Daniel E. Cooper, Stephen J. O'brien, Russell F WarrenAbstract:Based on anatomic and surgical dissections, the anatomy of the shoulder region is described in terms of four layers that overlie and support the glenohumeral joint. Each layer envelops the glenohumeral joint on its anterior, lateral, and posterior aspects, and between each layer there is a plane for safe and easy dissection. Layer 1 is composed of the deltoid and pectoralis major muscle bellies with their overlying Fascia and enveloping epimysium. Anteriorly, Layer 2 consists of the Clavipectoral Fascia, the conjoined tendon of the short head of the biceps and coracobrachialis, and the coracoacromial ligament. Posteriorly, Layer 2 is the dense posterior scapular Fascia that overlies the infraspinatus and teres minor muscle bellies
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Supporting layers of the glenohumeral joint. An anatomic study.
Clinical Orthopaedics and Related Research, 1993Co-Authors: Cooper De, Stephen J. O'brien, Russell F WarrenAbstract:: Based on anatomic and surgical dissections, the anatomy of the shoulder region is described in terms of four layers that overlie and support the glenohumeral joint. Each layer envelops the glenohumeral joint on its anterior, lateral, and posterior aspects, and between each layer there is a plane for safe and easy dissection. Layer 1 is composed of the deltoid and pectoralis major muscle bellies with their overlying Fascia and enveloping epimysium. Anteriorly, Layer 2 consists of the Clavipectoral Fascia, the conjoined tendon of the short head of the biceps and coracobrachialis, and the coracoacromial ligament. Posteriorly, Layer 2 is the dense posterior scapular Fascia that overlies the infraspinatus and teres minor muscle bellies. It is continuous with the Clavipectoral Fascia around the lateral aspect of the proximal humerus. Deep to Layer 2, the subdeltoid bursa yields a dissection plane that encompasses the anterior, lateral, superior, and variably the posterior aspects of the glenohumeral joint. Layer 3 consists of the deep layer of the subdeltoid bursa and the underlying musculotendinous units of the rotator cuff, including subscapularis, supraspinatus, infraspinatus, and teres minor. Layer 4 is the capsule of the glenohumeral joint. This includes the glenohumeral ligaments and coracohumeral ligament. These four layers were present and consistent in each shoulder dissected. Significant variations were present only within the deepest layer (shoulder joint capsule). This system can serve as a learning tool and will provide a more organized approach to facilitate surgical dissection in the region.
David Cibula - One of the best experts on this subject based on the ideXlab platform.
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Localization of the Sentinel Node of the Upper Outer Breast Quadrant in the Axillary Quadrants
Annals of Surgical Oncology, 2007Co-Authors: David Pavlista, Oldrich Eliska, Marketa Duskova, Michal Zikan, David CibulaAbstract:Background Sentinel node (SN) biopsy is associated with much less morbidity than axillary dissection. In patients with early breast cancer, lymphatic mapping and SN biopsy accurately stage the axillary nodes. Both currently available lymphatic mapping agents, radiocolloid and blue dye, have some limitations that may make perioperative or preoperative SN identification difficult. In such cases, exact knowledge of the topography of the axilla and the most probable location of the SN may be crucial. Methods In 12 fresh female cadavers with no history of breast carcinoma, injections of patent blue dye were used to visualize the SNs in the axillary quadrants and their lymphatic collectors from the upper outer quadrant of the breast, which is the most common location of breast cancer. The axilla was divided into quadrants with regard to the intersection of the thoracoepigastric vein and the third intercostobrachial nerve. Results All SNs were located within a circle of 2-cm radius of this intersection in the fatty tissue at the Clavipectoral Fascia. In most cases, the SN was located in the fatty tissue near the Clavipectoral Fascia in the lower ventral quadrant of the axilla (n = 14, 58%). In seven cases (29%), the SN was located in the upper ventral quadrant, in two cases (8%) in the upper dorsal quadrant, and in one case in the lower dorsal quadrant. Conclusions The results of this anatomical study may facilitate SN biopsy in patients with breast cancer.
Antonios Patrinos - One of the best experts on this subject based on the ideXlab platform.
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Erratum: The Clavipectoral Fascia as the unique anatomical criteria for distinguishing breast parenchymal lesions from axillary lymph node metastasis.
Journal of surgical case reports, 2019Co-Authors: Antonios Patrinos, Maria Zarokosta, John Tsiaoussis, George Noussios, Menelaos Zoulamoglou, Ioannis Flessas, Theodoros Piperos, Theodoros Mariolis-sapsakosAbstract:[This corrects the article DOI: 10.1093/jscr/rjz135.].
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the Clavipectoral Fascia as the unique anatomical criteria for distinguishing breast parenchymal lesions from axillary lymph node metastasis
Journal of Surgical Case Reports, 2019Co-Authors: Antonios Patrinos, Maria Zarokosta, John Tsiaoussis, George Noussios, τheodoros Piperos, Menelaos Zoulamoglou, Ioannis Flessas, Theodoros Mariolis SapsakosAbstract:: Diagnosing primary breast tumors of the axillary tail of Spence may be extremely challenging, since several lesions may be located in the axillary fossa. In the presented case, a 54-year-old post-menopausal Caucasian female patient presented to our institution complaining about a lump in her left axilla. The preoperative imaging modalities could not clarify whether the tumor is part of the tail of Spence or metastasis of the axillary lymph nodes. The diagnosis of primary adenocarcinoma of the axillary tail of Spence was made during a quadrantectomy of the left breast after the Clavipectoral Fascia, which constitutes the sole anatomical boundary between breast and axilla, was identified.