pectoralis


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thoracic

 [thŏ-ras´ik]
pertaining to the chest (thorax); called also pectoral.
thoracic outlet syndrome compression of the brachial plexus nerve trunks and subclavian vessels, with pain in the upper limbs, paresthesia of fingers, vasomotor symptoms, and weakness and wasting of small muscles of the hand; it may be caused by drooping shoulder girdle, a cervical rib (cervical rib syndrome) or fibrous band, an abnormal first rib, continual hyperabduction of the arm (as during sleep), or compression of the edge of the scalenus anterior muscle.
thoracic surgery surgical procedures involving entrance into the chest cavity. Until techniques for endotracheal anesthesia were perfected, this type of surgery was extremely dangerous because of the possibility of lung collapse. By administering anesthesia under pressure through an endotracheal tube it is now possible to keep one or both lungs expanded, even when they are subjected to atmospheric pressure. Thoracic surgery includes procedures involving the lungs, heart, and great vessels, as well as tracheal resection, esophagogastrectomy, and repair of hiatal hernia. In order to give intelligent care to the patient before and after surgery, one must have adequate knowledge of the anatomy and physiology of the chest and thoracic cavity. It is especially important to know the difference in pressures within and outside the thoracic cavity. (See also discussion of Mechanics of Inflation and Deflation, under lung.)
Patient Care. Prior to surgery the care of the patient will depend on the specific operation to be done and the particular disorder requiring surgery. In general, the patient should be given an explanation of the operative procedure anticipated and the type of equipment that will be used in the postoperative period. The patient will be taught the proper method of coughing to remove secretions accumulated in the lungs. Although coughing may be painful in the immediate postoperative period and may require analgesic medication to relieve the discomfort, if the patient understands the need for coughing up the secretions he or she will be more cooperative. Special exercises may be given to preserve muscular action of the shoulder on the affected side and to maintain proper alignment of the upper portion of his or her body and arm. Usually the physical therapist supervises these exercises, but the nursing staff must coordinate them with other aspects of patient care.



Narcotics are rarely given before thoracic surgery because they can depress respiration. Usually the preoperative medication is atropine in combination with a barbiturate.

The development of intensive care units has sharply improved the care of the post-thoracotomy patient. The availability of monitors, ventilators, and special assist devices has increased not only the safety of the operation but also the comfort of the patient. Many patients return from the operating room with endotracheal tubes still in place, ventilated by machines, and monitored with such special equipment as Swan-Ganz catheters for observation of cardiac output, oxygenation, and level of hydration.

During the postoperative period, alteration in respiratory status is a major potential problem for patients having thoracic surgery. Impaired gas exchange can result from atelectasis, pneumothorax, mediastinal shift, bronchopulmonary fistula, pneumonia, pleural effusion, pulmonary edema, narcotics, or abdominal distention. To identify any change in respiratory status, the patient's arterial blood gases are serially monitored, breath sounds are auscultated, and the rate and character of respirations are assessed. To facilitate removal of obstructive mucus and other secretions in the air passages the patient is encouraged to deep breathe and cough every one to two hours. Chest physical therapy may be ordered to help mobilize the secretions so that they are more easily coughed up. The amount and character of sputum is noted and recorded. If necessary, nasotracheal suctioning may be done to help clear the air passages. Oxygen may be administered to prevent anoxia.

The patient is also periodically assessed for pain, abdominal distention, and alteration in cardiac function related to decreased cardiac output, arrhythmias, or cardiac tamponade. If the pericardial sac becomes filled with fluid and produces an acute cardiac tamponade, an emergency pericardiocentesis may be necessary.

Almost all patients having thoracic surgery will have chest tubes. (One exception is the patient who has had a lung removed. In this case fluid is deliberately allowed to accumulate in the pleural space to prevent mediastinal shift.) Chest tubes are attached to closed drainage systems to avoid pneumothorax and allow for drainage of the pleural space and gradual reexpansion of the lung. (See chest tube for care.)

As the operative site heals and the lung expands, the chest tubes can be safely removed. After their removal an airtight bandage is applied to the area. As a precaution against leakage of air into the chest cavity, the physician may apply petrolatum to the edges of the wound before applying the dressing.

pectoralis

/pec·to·ra·lis/ (pek″tah-ra´lis) [L.] thoracic.

pectoralis

(pĕk″tō-rā′lĭs) [L.]
1. Pert. to the chest.
2. Any of the two overlapping muscles on each side of the anterior upper portion of the chest.

pectoralis major

A large triangular muscle that extends from the sternum to the humerus and functions to flex, horizontally adduct, and internally rotate the arm, and aids in chest expansion when the upper extremities are stabilized.

pectoralis minor

A muscle beneath the pectoralis major, attached to the coracoid process of the scapula that depresses as well as causes anterior tipping of the scapula.

pectoralis

[L.] pertaining to the chest or breast; pectoral.
References in periodicals archive ?
Various muscle transfers such as trapezius, pectoralis major and teres major, latissimus dorsi, combined biceps and triceps, gracilis, and combined muscle transfers have been used in the secondary reconstruction of the shoulder.
The pectoralis major and the anterior deltoid muscles did not show a difference for the bench press.
Pectoralis major muscle activity in the last repetition was significantly greater than the first repetition (pre-test: p = 0.
Devereaux, "A systematic review and comprehensive classification of pectoralis major tears," Journal of Shoulder and Elbow Surgery, vol.
Regional flaps like pectoralis major and the late dorsi may be too bulky for neck and face reconstruction4.
Especially effective for the pectoralis musculature is to use pin and stretch technique.
Bilateral, pectoralis majormyocutaneous flaps were used to cover the defect resulting from the excision.
pectoralis (otoliths, vertebrae, and cranial bone fragments), and a small amount of crustacean exoskeletal material (representing 1 pasiphaeid shrimp, cf.
Rupture of the pectoralis major muscle is most commonly a result of an indirect mechanism associated with extensive tension on a maximally contracted muscle.
Reconstruction methods were varied: 9 had single-layered primary closure, 14 had double-layered primary closure, 7 had triple-layered primary closure, 3 had pedicled pectoralis myocutaneous inlay flap without free tissue transfer, 9 had pedicled pectoralis myofascial onlay flap without free tissue transfer, and 4 had free tissue transfer.