• PNF and Movement
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• v.16 no.1
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• pp.143-150
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• 2018

Purpose: The purpose of this study was to investigate the influence of opposite lower extremity lateral muscle activation by proprioceptive neuromuscular facilitation (PNF) exercise targeting the lower extremities. Methods: Nineteen patients with chronic hemiplegia volunteered to participate in this study. PNF flexion, abduction, and internal rotation patterns; initial, end range, and extension patterns; abduction and internal rotation patterns; and initial and end range patterns were applied to the dominant lower extremity. Activation of lateral muscles (multifidus, gluteus medius, tensor fascia lata, and peroneous longus) of the paralyzed leg was then measured by electromyography (EMG). Results: There were significant differences in lateral muscle activation, depending on the PNF pattern applied, with the differences more significant in flexion, abduction, internal rotation, and end range patterns. Conclusion: PNF flexion, abduction, and internal rotation patterns can improve lateral muscle activation of one leg in the standing position in the gait cycle.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.282-286
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• 2021

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.70-79
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• 1996

From January 1980 to May 1995, ninety-six patients had been treated by free-flap transfer for the soft tissue defects of the extremities. Ninety-eight cases of free-tissue transfer were reviewed to evaluate the clinical reliability in terms of survival and quality of long-time function after reconstructive surgery. Among these 98 cases(27 cases in latissimus dorsi myocutaneous flap, 25 in dorsalis pedis flap, 20 in forearm fasciocutaneous flap, 9 in groin flap, 7 in gracilis myocutaneous flap, 6 in 1st web space flap of foot and 4 cases in tensor fascia lata flap), 92 cases of then were survived. 7 cases were performed with vein grafts. We ananalyzed the reconstruction of the extremities on 98 cases with the soft tissue defects which had been reconstructed free-flap transfer and followed for minimum 1 year period at Korea University Hospital. 1. 92 cases(93.9%) of the total 98 cases were successful and can be obtained the excellent results in soft tissue free-flap transfer. 2. While there were no clinically significant differences in survival rate of flaps transferred from different potential flap donor sites,3 cases of 9 groin flaps were showed higher failure rate due to the complications such as arterial thrombosis, infection and anatomical variation of vessels. 3. Postoperative thrombectomy was performed in 30 cases to be occured in the arterial and venous thrombosis. The revision was failed in 2 cases due to persistent arterial thrombosis and infection, then treated with skin graft. 4. Vein graft was frequently required in severely compromised-soft tissue defects resulted from high-energy trauma. The vein graft was not stitistically significant on the frequency of flap failure rate(P<0.04). 5. Meticulous monitoring, careful planning, early revision and technical considerations will provide for a high clinical success of the free-flap transfer.

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.130-136
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• 2012

Background : Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. Methods : A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. Results : We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from $4{\times}9cm$ ($36cm^2$) to $15{\times}30cm$ ($450cm^2$) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was $102^{\circ}$ (range, $45^{\circ}$ to $140^{\circ}$). Conclusions : In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

• Physical Therapy Korea
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• v.12 no.1
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• pp.111-119
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• 2005

The purpose of this study was to compare the differences of hip and thigh muscle activities between subjects with increased and decreased femoral anteversion during stair ascent. Twelve healthy female volunteers participated in this study. The subjects were divided into two groups (group 1 with increased anteversion of the hip, group 2 with decreased anteversion of the hip). This study analyzed differences in each mean peak gluteus maximus (GM), gluteus medius (GD) and tensor fascia lata (TLF) EMG amplitude: composite mean peak hip muscles (GM, GD, TFL) EMG amplitude ratios and in each mean peak vastus medialis oblique (VMO), vastus lateralis (VL), biceps femoris (HM) and semitendinosus (HL) EMG amplitude: composite thigh muscles (VMO, VL, HM, HL) EMG amplitude ratios among subjects with decreased or increased relative femoral anteversion. EMG ratios were compared in the stance and swing phase of stair ascent. Group 1 showed an increased standardized mean GM and GD EMG amplitude and decreased standardized mean TFL to composite mean hip muscles EMG amplitude ratios in stair ascent during both stance and swing phase. Also, group 1 showed an increased standardized mean HL EMG amplitude and decreased standardized mean VL and HM to composite mean thigh muscles EMG amplitude ratios in stair ascent during both stance and swing phases. There was no statistically significant difference in vastus medialis oblique between subjects with increased or decreased relative femoral anteversion. In order to provide rehabilitation professionals with a clearer picture of the specific requirements of the stair climbing task, further research must be expanded to include a wider range of age groups that represent the general public, such as including middle-aged healthy persons.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.2
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• pp.140-147
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• 2012

Microvascular reconstruction, in the oral and maxillofacial regions, is a widely accepted as the best way to overcome the complex oral cavity defects. Many patients requiring composite reconstructions have been treated previously with radiation therapy, chemotherapy, selective and/or functional neck dissection or any of these combinations. In many cases of these patients, inadequate neck vessels for the microanastomosis of free flap are available, due to a lack of recipient vessels in the neck, poor vessel quality or vessel caliber mismatch. To achieve a tension-free anastomosis, vein grafting must be considered to span the vessel gap between the free flap pedicle and the recipient neck vessels. Although most microsurgeons believed that interpositional grafts are to be avoided due to vessel thrombosis and increased number of necessary microanastomosis, we, authors have some confidence of equivalency between reconstruction with and without interpositional saphenous vein graft. The great saphenous vein, also known as the long saphenous vein, is the large subcutaneous superficial vein of the leg and thigh. It joins with the femoral vein in the region of femoral triangle at the saphenofemoral junction, and coursed medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata, called the saphenous opening. For a better understanding of the great saphenous vein graft for the interpositional vessel graft in the oral cavity reconstructions, and an avoidance of any uneventful complications during these procedures, the related surgical anatomies with their harvesting tips are summarized in this review article in the Korean language.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.203-208
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• 2007

Purpose: Myocutaneous flap was widely used for trochanteric pressure sore but it had many drawbacks such as donor site morbidity, dog-ear deformity and functional muscle sacrifice. We have performed fasciocutaneous flap based on perforating vessels and succeeded in overcoming its drawbacks. Methods: We experienced 11 cases of perforator-based fasciocutaneous flap for the coverage of trochanteric pressure sore in 9 patients, 2 cases of which were bilateral. The ambulatory status of patient group is as follows: 6 of them used a wheelchair, 2 of them are free walking, 1 of them use a wheelchair or crutches. Flap was supplied by cutaneous perforating vessel of descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. The size of wounds were from $4{\times}6.5cm$ to $10{\times}13cm$. Results: We did not find any flap loss or congestion except 2 partial wound dehiscences and 1 wound infection. Donor site morbidity was not found. We observed no recurrence of the pressure sore during the 2.5 year follow-up period. Conclusion: We considered that perforator-based fasciocutaneous flap could overcome the traditional drawbacks of the conventional myocutaneous flap and its modified flap for trochanteric pressure sore. And this flap has many advantages for covering trochanteric pressure sore without any donor site deformity and morbidity, which would greatly improve the aesthetic result.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.4
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• pp.123-129
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• 2018

PURPOSE: This study was conducted to investigate the influence of hip abduction angle on the muscle activity of the Gluteus Maximus (GM), Biceps Femoris (BF) and Tensor Fascia Lata (TFL) during Knee Flexed Prone Hip Extension exercise. METHODS: The subjects of this study were 42 healthy individuals. All participant consented to participate in this study. Subjects performed exercise, using the Knee Flexed Prone Hip Extension exercise in three hip abduction position $0^{\circ}$, $15^{\circ}$ and $30^{\circ}$. Subjects rested two minutes, between changing hip abduction position. Data were analyzed using a Noraxon MR-XP 1.08 Master Edition EMG to determine average amplitude, for each angle and muscle. All data were processed by Multivariate analysis of variance (MANOVA). There were a total of three groups. the GM muscle, BF muscle, TFL muscle. RESULTS: GM muscle activity was greatest in the $30^{\circ}$ hip abduction position (p<.05), followed by $0^{\circ}$. Between $0^{\circ}$ and $30^{\circ}$ has significant difference in muscle activity. However, the BF and TFL amplitude were greatest at $0^{\circ}$ hip abduction position followed by $30^{\circ}$. Moreover, the TFL differed significantly between $0^{\circ}$ and $30^{\circ}$, but, BF did not (p<.05). CONCLUSION: Hip abduction at $30^{\circ}$ was found to be the most appropriate position for GM muscle activity.

• Journal of Veterinary Clinics
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• v.35 no.3
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• pp.71-76
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• 2018

In 22 dogs with medial patellar luxation (MPL) of grade 3 or lower, resection of the vastus medialis oblique muscle, patellar anti-rotational suture, fascia lata overlap, and tibial tuberosity transposition (TTT) were undertaken to stabilize the patella without trochleoplasty. Data including signalment, clinical symptoms, details of the affected hindlimb, preoperative and postoperative patellar luxation grades, postoperative recovery time, and postoperative complications were obtained from medical records. The grade of lameness was evaluated preoperatively and postoperatively. Mean (${\pm}SEM$) grade of medial patellar luxation was $2.64{\pm}0.11$ preoperatively and $0.2{\pm}0.27$ postoperatively. Mean (${\pm}SEM$) grade of lameness was $1.73{\pm}0.27$ preoperatively and $0.18{\pm}0.15$ postoperatively. Patellar reluxation occurred in 1 of 22 (4.5%) cases requiring additional surgery. At final follow-up, 2 of the 22 (9.0%) dogs, including one with reluxation, had occasional lameness. Client-based questionnaire results demonstrated significant improvements in all parameters. Surgical treatment of MPL that included resection of the vastus medialis oblique without femoral trochlear groove deepening improved surgical outcomes in dogs with up to grade 3 MPL.

• The Korean Journal of Pain
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• v.34 no.2
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• pp.229-233
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• 2021

Background: Iliotibial band friction syndrome (ITBFS) is a common disorder of the lateral knee. Previous research has reported that the iliotibial band (ITB) thickness (ITBT) is correlated with ITBFS, and ITBT has been considered to be a key morphologic parameter of ITBFS. However, the thickness is different from inflammatory hypertrophy. Thus, we made the ITB cross-sectional area (ITBCSA) a new morphological parameter to assess ITBFS. Methods: Forty-three patients with ITBFS group and from 43 normal group who underwent T1W magnetic resonance imaging were enrolled. The ITBCSA was measured as the cross-sectional area of the ITB that was most hypertrophied in the magnetic resonance axial images. The ITBT was measured as the thickest site of ITB. Results: The mean ITBCSA was 25.24 ± 6.59 ㎟ in the normal group and 38.75 ± 9.11 ㎟ in the ITBFS group. The mean ITBT was 1.94 ± 0.41 mm in the normal group and 2.62 ± 0.46 mm in the ITBFS group. Patients in ITBFS group had significantly higher ITBCSA (P < 0.001) and ITBT (P < 0.001) than the normal group. A receiver operator characteristic curve analysis demonstrated that the best cut-off value of the ITBT was 2.29 mm, with 76.7% sensitivity, 79.1% specificity, and area under the curve (AUC) 0.88. The optimal cut-off score of the ITBCSA was 30.66 ㎟, with 79.1% sensitivity, 79.1% specificity, and AUC 0.87. Conclusions: ITBCSA is a new and sensitive morphological parameter for diagnosing ITBFS, and may even be more accurate than ITBT.