Background: Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction. Purpose: The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome. Study Design: Case series; Level of evidence, 4. Methods: Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively. Results: Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores ( r = 0.628, P = .016) and less forward flexion ( r = –0.502, P = .048) and external rotation ( r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction. Conclusion: This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.
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机译：背景：避免延误胸大肌（PM）破裂的外科手术治疗可优化结果。但是，这并非总是可能的，当泪液变得慢性或亚急性泪液的组织质量较差时，移植物可以促进重建。目的：主要目的是评估同种异体真皮移植治疗慢性泪液或组织质量较差的亚急性泪液的PM重建的临床效果。第二个目的是确定影响结果的患者和手术因素。研究设计：案例系列;证据等级：4。方法：对19例平均±SD年龄为39.1±8.4岁的连续患者（19例PM破裂）进行回顾性研究，结果表明同种异体植皮重建PM肌腱后26.4±16.0个月。在受伤后的19.2±41.2个月进行手术（中位数为7.6个月;范围为1.1-185.4个月）。术前和术后记录了多个结果评分，包括手臂，肩膀和手部残疾（DASH）以及视觉模拟量表（VAS）（范围0-10; 0 =无疼痛）和单项评估数字评估（SANE）术后记录运动范围，恒定评分，美国肩肘外科医师（ASES）评分，简单肩部测试评分以及并发症/再次手术。结果：DASH（术前34.9;术后8.0; P <.001）和VAS（术前5.0;术后1.5; P = 0.011）的得分显着提高。 SANE评分有改善的趋势（术前为15.0;术后为80.0; P = .097），但差异无统计学意义，这可能是因为术前接受SANE评分的患者较少。年龄的增加与较高的VAS评分（r = 0.628，P = .016）和较少的前屈（r = –0.502，P = .048）和外旋（r = –0.654，P = .006）相关。获得工人补偿的患者在3个指标上得分较低：SANE（75.8 vs 88.4，P = .040），Constant（86.7 vs 93.4，P = .019）和ASES（81.9 vs 97.4，P = .016）。在优势肢上进行手术会导致恒定得分较低（87.8 vs 95.4，P = .012）。 2头肌腱撕裂（107.5°vs 123.3°，P = .033）和使用> 1移植物（105.0°vs 121.3°，P = .040）导致外展减少。结论：这是第一个大型系列，观察了同种异体真皮移植治疗的慢性或亚急性PM肌腱撕裂患者。用真皮同种异体重建PM肌腱可产生良好的客观和主观患者报告结果。
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