rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle...

Rotation of the Clavicular Portion of the Pectoralis Major for Soft-Tissue Coverage of the Clavicle

by G. R. Williams, K. Koffler, M. Pepe, K. Wong, B. Chang, and d. M. Ramsey

J Bone Joint Surg AmVolume 82(12):1736-1736

December 1, 2000

©2000 by The Journal of Bone and Joint Surgery, Inc.

Cadaveric anatomical dissection showing the rotated flap (arrows), with the origin intact, prior to division of the acromial branch of the thoracoacromial trunk.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.

Radiograph showing a midshaft clavicular nonunion with atrophic medial and lateral fragments.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.

Figs. 3-A, 3-B, and 3-C: Illustrations showing the surgical technique for use of a rotational pectoralis major flap.Fig. 3-A: The interval between the sternocostal and clavicular heads is

identified and dissected distally and laterally.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.

A separate skin incision is made over the humeral insertion, and the tendon of the clavicular head is identified and incised.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.

The vascular pedicle becomes more superficial with rotation of the flap.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.

Clinical photograph showing the healed clavicular incision and the contouring flap.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.

Radiograph made twenty-one months postoperatively, showing a healed nonunion of the clavicle.

G. R. Williams et al. J Bone Joint Surg Am 2000;82:1736

©2000 by The Journal of Bone and Joint Surgery, Inc.