title: Rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle. An anatomical study and case report.
abstract: BACKGROUND
  The purposes of this study were to describe the anatomical features of a rotational flap consisting of the clavicular portion of the pectoralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple operations for a clavicular fracture complicated by nonunion and infection.
  
  
  METHODS
  Ten shoulders from five cadavera were dissected to isolate the clavicular portion of the pectoralis major. The vascular pedicle, thoracoacromial artery, and axillary artery were identified, and the length of the vascular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the flap about its intact clavicular origin was measured before and after division of the acromial branch of the thoracoacromial artery. The clavicular origin was then incised, and the overall length, width, and thickness of the muscle as well as the distance from each end of the muscle to the vascular pedicle were measured.
  
  
  RESULTS
  The average length of the vascular pedicle from the axillary artery to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acromial branch and 73 degrees (range, 65 to 82 degrees) after division. The average total length of the clavicular head was 20.2 centimeters (range, 18.0 to 23.0 centimeters). The average width of the clavicular head was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered the muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) lateral to the most medial extent of the muscle and an average of 11.5 centimeters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle. The rotational flap was successfully used clinically to provide soft-tissue coverage after bone-grafting and internal fixation of a clavicular nonunion that had been complicated by infection.
  
  
  CONCLUSIONS
  The clavicular head of the pectoralis major may be used as a local rotational flap to cover soft-tissue deficiencies over the clavicle. It can be harvested with relative ease without damaging the sternocostal head.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Williams
authors.forename: K
authors.initials: K
authors.lastname: Koffler
authors.forename: M
authors.initials: M
authors.lastname: Pepe
authors.forename: K
authors.initials: K
authors.lastname: Wong
authors.forename: B
authors.initials: B
authors.lastname: Chang
authors.forename: M
authors.initials: M
authors.lastname: Ramsey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation*; D011859:Radiography; D012086:Reoperation; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D014946:Wound Infection / Q000601:surgery*