• Archives of Plastic Surgery
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• 제35권6호
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• pp.663-668
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• 2008

Purpose: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. Methods: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. Results: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9 - 3.4cm and 1.8 - 3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7 - 7.0 cm on medial margin and 6.2 cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8 - 5.6 cm on medial margin and 2.7 - 6.2 cm on lateral margin. Conclusion: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8 cm on medial margin and 1.9 cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.71-74
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• 2010

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• Archives of Plastic Surgery
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• 제50권2호
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• pp.166-170
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• 2023

Diaphragmatic reconstruction is required for extensive diaphragmatic defects associated with tumor resection. Methods using artificial mesh and autologous tissues, such as pedicled flaps, have been reported predominantly for diaphragmatic reconstruction. We present the case of a 61-year-old woman who presented with a 14×13×12 cm tumor in the abdominal cavity of the upper left abdomen on computed tomography. The diaphragm defect measuring 12×7 cm that occurred during excision of the malignant tumor was reconstructed using the rectus abdominis muscle and fascial flap. The flap has vertical and horizontal vascular axes; therefore, blood flow is stable. It also has the advantage of increasing the range of motion and reducing twisting of the vascular pedicles. Fascial flap does not require processing such as thinning and can be used during suture fixation. This procedure, which has rarely been reported so far, has many advantages and may be a useful option for diaphragm reconstruction.

• 대한물리치료과학회지
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• 제10권2호
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• pp.96-103
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• 2003

The purpose of this study was to assess the effect of applied pressure to abdomen on lumbar and abdominal muscle activation during upper limb exercise. The experimental group consisted of twenty-seven healthy male subjects (mean age=$22.40{\pm}2.19years$, mean height=$175.30{\pm}2.19cm$, mean weight= $67.67{\pm}7.44kg$, RM=$8.43{\pm}2.76kg$). In each different pressure condition (OmmHg, 30mmHg, 70mmHg, 100mmHg), upper limb exercise was performed in total of 10 trials with 10 RM dumb-bell exercise. Lumbar and abdominal muscle activity was measured using surface bipolar electrode electromyography(EMG). EMG activity was measured from upper rectus abdominis, external oblique abdominis, internal oblique abdominis, and elector spinae. The raw EMG signal was processed into the root mean square(RMS). All RMS EMG data were normalized and express as a percentage of the EMG(%EMG). Collected data were statistically analyzed by SPSS/PC Ver 10.0 using two-way analysis of variance for repeated measures($4{\pm}3$) and Bonferroni post hoc, test. Lumbar and abdominal muscle activation was significantly increased when 100 mmHg was applied(p<.05). Upper rectus abdominis activation was significantly increased compared as other muscles activation(p<.05). However, there were no interaction between pressure and muscles(p>.05). The findings of this study can be used as a fundamental data when lumbar orthosis is applied and external pressure can be used as a therapeutic tool.

• Physical Therapy Rehabilitation Science
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• 제10권4호
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• pp.444-449
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• 2021

Objective: The purpose of this study is to observe the change in the thickness of abdominal muscles when electrical muscle stimulation (EMS) is applied to the abdomen during rest and abdominal muscle exercise to investigate the effect of EMS applied to the abdomen on the superficial and deep muscles thickness. Design: Cross sectional design. Methods: Twenty healthy subjects participated in this study. Subjects were performed resting position, resting position with EMS, curl-up and curl-up with EMS. The electrode of the EMS belt is attached to the abdominal wall between the 12th rib and iliac crest. The thickness of abdominal muscles including rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) were captured in each position by ultrasound image during expiration. All subjects were performed four positions randomly. Data were analyzed using repeated ANOVA with the level of significance set at 𝛼=0.05. Results: The muscle thickness of RA, EO, IO and TrA were significantly different at each position (p<0.05). The thickness of all abdominal muscles increased significantly when curl-up than curl-up with EMS. Both RA and EO thickness were significantly increased at resting position than resting position and EMS were combined(p<0.05). But IO and TrA thickness were decreased at resting position when EMS were combined. Conclusions: The results suggest that EMS activates superficial abdominal muscles RA and EO. Therefore, abdominal strengthening exercise combined EMS can activate abdominal muscles and can be applied to various patients and rehabilitation in clinical practice.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.571-576
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• 2010

Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.229-236
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• 2007

Purpose: Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. Methods: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system. Results: Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities. Conclusion: The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.

• 대한물리의학회지
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• 제5권3호
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• pp.405-412
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• 2010

Purpose : The purpose of this study was to assess the effects of the trunk muscle activity on bridging exercise according to the knee joint angle. Methods : Twenty-five healthy adults volunteered to participate in this study. Subjects were required to complete following four bridging exercises; knee joint flexion $120^{\circ}$, $90^{\circ}$, $60^{\circ}$, $45^{\circ}$. Surface electromyography from selected trunk muscles was normalized to maximum voluntary isometric contraction. Muscle activity was measured by QEMG-4 system(LXM 3204, Laxtha Korea). A repeated measures of one-way ANOVA with post-hoc Bonferroni's correction was used to determine the influence of bridging exercise on muscle activity for each muscle and descriptive statistics was used to determine local/global muscle ratio. Results : The internal oblique of bridging exercises $120^{\circ}$, $90^{\circ}$ showed significantly(p<.05). The erctor spinae of all bridging exercises showed significant excepted between $60^{\circ}$ and $45^{\circ}$(p<.05). Median of internal oblique/rectus abdominis ratio of $120^{\circ}$ was 4.41, $90^{\circ}$ was 3.94, $60^{\circ}$ was 3.58, $45^{\circ}$ was 3.39. Median of internal oblique/external oblique ratio of $120^{\circ}$ was 2.66, $90^{\circ}$ was 2.43, $60^{\circ}$ was 2.87, $45^{\circ}$ was 2.64. Conclusion : Angular motion decreasing with knee joint flexion made erector spinae activation increase. on the other hand, as decreasing abdomen muscle activation, the more performing motor learning is required for abdomen muscle strength and co-contraction for the trunk stabilization.