Neurovascular Anatomy

A small branch of the lateral pectoral nerve innervates the upper muscular slip while the medial pectoral nerve supplies the remaining muscular slips. The main trunk of the lateral pectoral nerve passes through the minor muscle to supply the pectoralis major muscle. The blood supply is variable and dual: superomedially from the thor- |

acoacromial artery and vein and inferolaterally from the lateral thoracic artery and vein (Fig. 33). The dominant vascular pedicle is usually the lateral thoracic contribution and the arterial diameter is less than 1mm. The venous anatomy is variable. 2 A separate suitable vein or the vena comitantes is available for anastomosis.

Surgical Highlights |

Since the pectoralis minor muscle is a deep structure, there are no surface landmarks o except those relating to the relative position of the pectoralis major muscle and cor- ยง

acoid process. The access incision is placed along the anterior axillary fold. Dissec- @

Figure 33 The important neurovascular anatomy of the pectoralis minor muscle flap. Note how a small branch of the lateral pectoral nerve innervates the upper muscular slip, while the medial pectoral nerve supplies the remaining muscular slips. The dominant vascular pedicle is usually the lateral thoracic artery.

Figure 33 The important neurovascular anatomy of the pectoralis minor muscle flap. Note how a small branch of the lateral pectoral nerve innervates the upper muscular slip, while the medial pectoral nerve supplies the remaining muscular slips. The dominant vascular pedicle is usually the lateral thoracic artery.

tion proceeds to the lateral border of the pectoralis major muscle where the lateral thoracic vascular pedicle is identified. The lateral thoracic pedicle is followed to its branch to the pectoralis minor muscle. The muscle is dissected along its outer and inner surfaces to expose the pectoral nerves, veins, and thoracoacromial vascular pedicle. The dominant vascular structures are noted and preserved. Prior to flap harvest, fine silk sutures are placed in exactly 1 cm increments along the inferior border of the muscle corresponding to the inferior-most muscular slip. These sutures mark the in situ tension of the muscle. The harvested muscle is placed over a template from the face and stretched to approximate the desired resting tension. The template serves to gauge the distances between the body of the zygoma (insertion point of the proximal muscle) and the insertion points for the muscular slips (alar base, nasolabial fold, modiolus, and lower lip). The muscular slips are trimmed as needed. Once the muscle is inset, the microvascular and neural anastomoses can proceed.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment