A Neurotomia Study On Partial Pectoralis Minor Transplantation For Reconstructing Thumbopposition Function

Objective To provide anatomical evidence on nerve for the operation of using pectoralis minor muscle transplantation to reconstruct thumbopposition function.Methods 22 unembalmed fresh adult cadaveric hands and 16 unembalmed fresh adult cadaveric thoracic parts were obtained,the deep branches of the ulnar nerve and the medial pectoral nerves were exposed and investigated。According to neurorrhaphy in the operation, some nerve specimens were dissected,formalin fixed,paraffin embedded,cross cut,HE stained,and the number of myelinated nerve fibers in the nerve cross-sectional were calculated by using IAS(image analysis system).Making a comparison of the number of myelinated nerve fibers between the medial pectoral nerves and the deep branches of ulnar nerve,refering to the number of myelinated nerve fibers of the recurrent branch of median nerve,then it can be identified that which branch of ulnar nerve should be sutured with the medial pectoral nerve.Results Through medial intermuscular septum,the deep branch of the ulnar nerve respectively gave rise to a conspicuous branch in the fourth and third spatia interossea metacarpio At 5mm distal to origin point,the number of myelinated nerve fibers of these branches respectively were 708±78,394±49。The medial pectoral nerve had a dominant role in the pectoralis minor muscle irmervation in contrast to the lateral pectoral nerve。The medial pectoral nerve or it's the most medial branches pierce the pectoralis minor in the midclavicular line over the third intercostal space,a mean of 88.95mm lateral to the margin of the sternum.At 15mm distal to innervation point,the number ofmyelinated nerve fibers of the medial pectoral nerve were 868±130.At 5mm distal to origin point,the number of myelinated nerve fibers of the recurrent branch of median nerve were873±76。The number of myelinated nerve fibers was not significant difference between the recurrent branch of median nerve and the medial pectoral nerve(p＞0.05 )。The number of myelinated nerve fibers of the P3L4,which was one branch of the deep branches of the ulnar nerve,was approximate to that of the recurrent branch of median nerve and the medial pectoral nerve.Conclusions In the clinical operation of using pectoralis minor muscle transplantation to reconstruct thumbopposition function,we should regard the medial pectoral nerve as the donor nerve when transplanting pectoralis minor muscle,and search the nerve in the midclavicular line over the third intercostal space;It is better that the P3L4 be anastomosed with the medial pectoral nerve。...