Sternalis muscle

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
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Details: Published: August 16, 2017

Sternalis muscle (Andreas Vesalius 1543)

The Sternalis muscle has been nominated as a supernumerary anatomical variation; the highest prevalence is in China (23.5%) and the lowest in Chile (0.87%).

The muscle is a wide band of muscular tissue located in the anterior thoracic wall, where fibers travel near-parallel to the sternum, inferior to the clavicles, aterior to the pectoralis major and the pectoral fascia. It has received many names: rectus sternalis, parasternal, episternal, superficial abdominal rectus, among other names. To avoid confusion, a true sternalis muscle should have the following characteristics:

(1) be localized between the subcutaneous tissue of the anterior thoracic region and fascia pectoralis;
(2) originate superiorly from the sternum or infraclavicular region;
(3) be inserted inferiorly in the ribs, rib cartilage, external oblique muscle aponeurosis and sheath of the rectus abdominis muscle;
(4) its innervation must come from the anterior root of the intercostal nerves. Another possible innervation from medial and lateral pectoral nerves has been mentioned.

Even though the Sternalis muscle does not appear to have a significant function, it is important to bear it in mind when evaluating mammograms, because one could misdiagnose it as a mammary cancer, as exposed by many authors. It is crucial to be familiar with this muscle to avoid confusion with pathology, such as extra-abdominal desmoid tumors, diabetic mastopathy, abscesses, hematomas, fat necrosis, and others; its unilateral presence may cause breast or chest asymmetry.

Note: The image in this article depicts this variation and is from the 1543 " De Humanis Corporis Fabrica, Libri Septem " by Andreas Vesalius.

Sources:
1. Jelev L., Georgiev G., Surchev L. (2001) The sternalis muscle in the Bulgarian population: classification of sternales. J. Anat. 199: 359-363.
2. Bradley F.M., Hoover H.C., Hulka C.A., Whitman G.J., McCarthy K.A., Hall D.A., Moore R., Kopans D.B. (1996) The sternalis muscle: an unusual normal finding seen on mammography. AJR. Am. J. Roentgenol. 166: 33-36.
3. Scott-Conner C.E.H., Al-Jurf A.S. (2002) The sternalis muscle. Clin. Anat. 15: 67-69.
4. Shiotani M., Higuchi T., Yoshimura N., Kiguchi T., Takahashi N., Maeda H., Aoyama H. (2012) The sternalis muscle: radiologic findings on MDCT. Jpn. J. Radiol. 30: 729-734.

Sternalis muscle

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