Beheiry Eman Elazab
Department of Anatomy and Embryology, Alexandria University, Alexandria, Egypt.
Ann Plast Surg. 2012 Feb;68(2):209-14. doi: 10.1097/SAP.0b013e318212f3d9.
Owing to the diverse application of the pectoralis major muscle (Pmaj) in reconstructive surgery, with special reference to its safe and functional transfer, a precise knowledge of its nerve supply becomes mandatory. The aim of the present study was to investigate its innervations.
A total of 30 specimens of pectoral regions pertaining to 15 embalmed adult human cadavers, aged between 30 and 67 years (10 males, 5 females), were dissected in pursuit of this aim.
The proximal and the upper third of the distal segments of the muscle were constantly supplied by the ventral division, through medial and lateral branches, and the dorsal division of the lateral pectoral nerve, respectively. The ventral branches of either the pectoral loop (in 26/30 specimens) or the medial pectoral nerve (MPN) (4/30) penetrated the upper third of the pectoralis minor to supply the lower two-thirds of the distal segment of the Pmaj through 1 or 2 branches. Concomitantly, the dorsal branch of either the MPN (26/30) or the pectoral loop (4/30) supplied the posterior limb of its tendon. The fourth intercostal nerve participated in the inferolateral muscle supply (4/30).
The muscle is mainly innervated by the lateral pectoral nerve supplemented by the branches of the MPN. The proximal segment, having a separate nerve, allows its functional transfer. Care should be practiced whenever the distal segment is to be harvested, because of having multiple nerves.
由于胸大肌（Pmaj）在重建手术中的多种应用，特别是其安全且功能性的转移，精确了解其神经供应变得至关重要。本研究的目的是调查其神经支配情况。
为实现这一目的，解剖了15具年龄在30至67岁之间（10例男性，5例女性）的经防腐处理的成人尸体的30个胸部标本。
该肌肉近端和远端节段的上三分之一分别由胸外侧神经的腹侧支通过内侧和外侧分支以及背侧支持续供应。胸肌袢（26/30个标本）或胸内侧神经（MPN）（4/30）的腹侧支穿过胸小肌上三分之一，通过1或2个分支供应胸大肌远端节段的下三分之二。同时，胸内侧神经（26/30）或胸肌袢（4/30）的背侧支供应其肌腱的后肢。第四肋间神经参与下外侧肌肉的供应（4/30）。
该肌肉主要由胸外侧神经支配，并由胸内侧神经的分支辅助。近端节段有独立的神经，允许其进行功能性转移。由于远端节段有多条神经，在进行取材时应格外小心。
