title: Fascial release of the pectoralis major: a technique used in pectoralis major muscle closure of the mediastinum in cases of mediastinitis.
abstract: BACKGROUND
  The authors' goal was to demonstrate a technique of gaining added width from the right pectoralis major muscle flap through muscle fascia release, with the hope of attaining sturdier, tension-free dead space closure of the debrided mediastinum in cases of mediastinitis.
  
  
  METHODS
  The authors measured the preincisional and postincisional widths of the right pectoralis major flap following release of the fascia in nine patients who underwent mediastinal reconstruction using pectoralis major muscle flaps from 2002 to 2004 at the Detroit Medical Center.
  
  
  RESULTS
  The average width of the nine muscles was 16.3 +/- 1.7 cm before fascia release and 22.1 +/- 1.3 cm after release. The average increase in width was 5.8 +/- 1.3 cm, with a 95 percent confidence interval of 4.8 to 6.8 cm. A value of p < 0.0001 indicated that this increase in width was statistically significant. After fascial release, the width of the muscles increased by an average of 26.1 percent, with a 95 percent confidence interval of 21.6 to 30.6 percent.
  
  
  CONCLUSIONS
  The authors present a new technique that can be used to gain additional width from the right pectoralis major muscle in cases of mediastinal reconstruction using the pectoralis major muscle flap. With the added 26 percent of width obtained from the right pectoralis major muscle with fascia release, the authors contend that a sturdier and tension-free closure of the mediastinal dead space can be obtained, further expanding the indications for use of the pectoralis major muscle flap as the sole closure modality in even the most complicated cases of mediastinitis.
authors.affiliation: Department of General Surgery, Division of Plastic and Reconstructive Surgery, Wayne State University, Harper Professional Building, Suite 400, 4160 John R Street, Detroit, Mich. 48201, USA. amspiess@msn.com
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Spiess
authors.forename: Chenicheri
authors.initials: C
authors.lastname: Balakrishnan
authors.forename: Eti
authors.initials: E
authors.lastname: Gursel
mesh_terms: D000071938:Fasciotomy; D006801:Humans; D008480:Mediastinitis / Q000209:etiology / Q000601:surgery*; D008482:Mediastinum / Q000601:surgery; D010369:Pectoralis Muscles / Q000601:surgery*; D013249:Sternum / Q000601:surgery; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects; D014947:Wounds and Injuries / Q000601:surgery*