Macchi Veronica, Tiengo Cesare, Porzionato Andrea, Parenti Anna, Stecco Carla, Mazzoleni Francesco, De Caro Raffaele
Department of Human Anatomy and Physiology, Section of Anatomy, University of Padova, Padova, Italy.
Clin Anat. 2007 Mar;20(2):157-62. doi: 10.1002/ca.20328.
During modified radical mastectomy or cosmetic surgery, denervation of the lower part of the pectoralis major frequently occurs and may reduce muscle spasm, with consequent better reconstruction of the breast. The aim of this study was to determine the relationship between the pectoral nerves and the pectoral muscles. Eight unembalmed female cadavers were dissected and vascular and radiologic studies performed. The lateral pectoral nerves showed a constant course, parallel to the thoraco-acromial vessels. They coursed for 55 +/- 7 mm inferomedially on the deep surface of pectoralis major, under its fascia. The medial pectoral nerves showed two main patterns of branching, which correlated with the extent of the costal attachments of the pectoralis minor muscles. In pattern A (56%), associated with costal attachments narrower than 6.0 cm, the nerve pierced the deep aspect of the pectoralis minor as a single trunk, ramified in the muscle, and gave some branches that appeared on the superficial aspect to enter the pectoralis major. In pattern B (44%), associated with costal attachments wider than 6.6 cm, the nerve divided before entering pectoralis minor and its branches passed through the muscle or round its lower border to reach pectoralis major. The most medial branch of the medial pectoral nerve directed to the pectoralis major muscle emerged from pectoralis minor at the third intercostal space in the midclavicular line, a mean of 10.3 cm lateral to the margin of the sternum. Knowledge of the relationship between the extent of the costal attachment of pectoralis minor and the two patterns of branching of the medial pectoral nerve may be useful when performing elective denervation of the major pectoralis muscle.
在改良根治性乳房切除术或整形手术过程中，胸大肌下部的去神经支配经常发生，这可能会减少肌肉痉挛，从而更好地进行乳房重建。本研究的目的是确定胸神经与胸肌之间的关系。解剖了8具未防腐处理的女性尸体，并进行了血管和放射学研究。胸外侧神经走行恒定，与胸肩峰血管平行。它们在胸大肌深面、筋膜下向内下走行55±7mm。胸内侧神经显示出两种主要的分支模式，这与胸小肌肋附着范围相关。在模式A（56%）中，与肋附着宽度小于6.0cm相关，神经作为单干穿过胸小肌深面，在肌肉内分支，并发出一些分支出现在浅面进入胸大肌。在模式B（44%）中，与肋附着宽度大于6.6cm相关，神经在进入胸小肌前分支，其分支穿过肌肉或绕过其下缘到达胸大肌。胸内侧神经最内侧指向胸大肌的分支在锁骨中线第三肋间从胸小肌穿出，距胸骨边缘平均外侧10.3cm。了解胸小肌肋附着范围与胸内侧神经两种分支模式之间的关系在进行胸大肌选择性去神经支配时可能有用。
