• Archives of Plastic Surgery
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• 제42권5호
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• pp.596-600
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• 2015

Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.31-36
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• 2010

Purpose: The primary goal of palatoplasty is to enable normal speech with harmonious growth of face. Some children who had palatoplasty display typical findings of transverse maxillary deficiency requiring orthodontic widening of the maxilla. Levi (2009) described a cleft palate repair coupled with pedicled buccal fat pad flaps to cover bone exposed areas of the hard palate. Hence we report clinical experiences of cleft palate repair using pedicled buccal fat pad flap. Methods: Four Veau class II and a Veau class I cleft palate patients underwent palatoplasty with buccal fat pad flap by single surgeon from April 2009 to August 2009. Two patients received 2-flap palatoplasty and three patients 1-flap palatoplasty, respectively. After the cleft palate repair, sharp mosquito scissors was placed in the superior buccal sulcus just lateral to the maxillary tuberosity and inserted directly through the mucosa resulting in buccal fat pad extrusion. The elevated flap was moved to cover mucoperiosteal defect in hard palatal area. Results: Five patients underwent primary palatoplasty using buccal fat pad flap. Flap harvest and inset took on average 9 minutes per flap. Mucosal epithelization took 18 days on average. No patients had complications related to the buccal fat pad flap. Conclusion: Buccal fat pad pedicled flap has significant potential to function as an added vascularized tissue layer in cleft palate repair and we can expect better growth of maxilla with this method although longer duration of follow-up was unavailable.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.503-506
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• 2009

Purpose: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. Methods: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turn overed flap is fixed on the upper portion of the chest wall of the mastectomy site. Results: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and natural shape. Conclusion: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than that of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

• Archives of Plastic Surgery
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• 제44권1호
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• pp.34-41
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• 2017

Background The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach. Methods From July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of $20.1kg/m^2$. In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously. Results One case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others. Conclusions With superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients.

• 감성과학
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• 제5권4호
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• pp.67-75
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• 2002

뇌기능 장애 환자에서 자세균형 제어능력의 저하는 보행 및 일상생활동작 수행 등에 어려움을 초래하며 이에 대한 정확한 평가 및 치료를 위하여 일상의 환경변화와 유사한 상황을 제공하고 이에 따른 자세균형 조절 능력을 파악하는 것이 중요하다. 본 연구는 뇌기능 장애 환자에서 가상적 움직이는 환경에 따른 자세균형 조절 기능을 정확히 평가하고 환경의 움직임이 자세균형 조절에 미치는 영향을 분석하였다. 15명의 뇌기능 장애 환자들과 정상인 15명을 대상으로 실생활과 유사한 환경의 조성을 위하여 HMD를 이용한 가상 환경 움직임(Virtual Moving Surround)을 네 가지 다른 패턴으로 제공하였다. 자세동요의 정도는 힘판을 이용하여 신체압력중심의 변화를 전체이동거리, 동요주파수, 최대 빈도 COP 위치로 측정하였으며 가상 환경의 차이에 따른 변화를 비교 분석하였다. 연구결과 검사 재검사 신뢰도평가에서 일관된 분석결과를 나타냈고 뇌 기능장애 환자와 정상인의 분석에서는 두 그룹간의 차이를 확인할 수 있었다. 특히 전후로 빠르게 변하는 가상 환경에서 가장 큰 자세동요를 나타내었고 통계적으로 유의한 차이가 있었다. 본 연구를 통해 뇌기능 장애 환자에서 가상 환경 변화가 자세균형 조절에 미치는 영향을 확인할 수 있었으며 이러한 환자들을 위한 치료와 평가 환경 조성 등에도 유용한 자료로 쓰일 수 있을 것으로 사료된다

• Journal of Chest Surgery
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• 제12권3호
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• pp.207-214
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• 1979

This 3-year-old girl was observed frequent exertional dyspnea and cyanosis at crying since birth. She was not premature baby and delivered at full term normally. On physical examination, she was underdeveloped-body weight 13.5 kg, height 99 cm.- and cyanotic. There was severe clubbing on fingers. There was grade II/VI ejection systolic murmur on left lateral border of the sternum. The preoperative examinations [EKG, echocardiogram, cardiac catheterization and biventriculogram] showed that complicated T.G.A. combined vena cava[S.D.D.]. Preoperatively, we decided the corrective surgery of Rastelli operation using a. pulmonary valved conduit. The operation was performed under total circulatory arrest using deep profound hypothermia combining with extracorporeal circulation. On operation, the anatomy of the heart showed that, 1. The subaortic conus was seen and subaortic muscles were hypertrophied. 2. The VSD[type II], behind the subaortic conus-about 1 cm. in diameter, was visible only through LV cavity and, 3. The pulmonary valve ring was hypoplastic and pulmonary valvular stenosis was seen also. The subpulmonic area [LV outflow tract] was obstructed with hypertrophied muscle and mitral valve. 4. Left superior vena cava was drained to RA via coronary sinus. 5. LAD coronary artery was originated from right coronary artery and ran anterior to the pulmonary artery. According to above anatomy, we performed the VSD closure with Teflon patch, and Mustard operation combined with LV-to-pulmonary artery bypass graft using the valve contained [Hancock 16 mm] conduit. Postoperatively, adequate blood pressure could be maintained under the state of using inotropic agent [epinephrine]. On the second postoperative day, the patient died of cardiac arrest due to low cardiac output syndrome, acute renal failure and pulmonary edema.

• Journal of Chest Surgery
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• 제12권3호
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• pp.174-182
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• 1979

This is a report on four cases of successful surgical correction of coarctation of the aorta [COA] in Department of the Thoracic & Cardiovascular Surgery, Hanyang University Hospital. The first case was a postductal type of coarctation of the aorta associated with Patent ductus arteriosus [PDA], Persistent left superior vena cava [LSVC] and richly developed collateral circulation. Blood pressure was measured to be hypertensive at the arm, but hypotensive at the legs. The coarctation of the aorta was corrected with following procedure: Partial resection of the aortic wall with diaphragmatic structure lust above and below the coarctating line of the aorta, and then the defect of the aortic wall was closed by lateral aortographic suture. PDA was closed by ligation procedure. The second case a preductal type of coarctation of the aorta associated with PDA, LSVC, ventricular septal defect [VSD] and poorly developed collateral circulation. Normal blood pressure was measured at the arm, but hypotension was observed at the legs. Correction of coarctation of the aorta was performed under the establishment of tube bypass because of poor collateral circulation. After resection of coarctating short segment, end to end anastomosis was performed without any tension. PDA was closed by division procedure. Simple suture closure of VSD was performed by open heart surgery two weeks after correction of COA. The third case was a long segment COA without any other anomaly. Blood pressure was measured to be hypertensive at the arm, but hypotensive at the legs. Vascular prosthesis was performed using Teflon graft tube after resecting coarctating long segment [6.5 cm] of the aorta. The fourth case was a long segment COA associated with aortic insufficiency and richly developed collateral circulation. Normal blood pressure was measured at the arm, but hypotension was observed at the legs. Vascular prosthesis was performed using Teflon graft tube after resecting coarctating long segment [6.0 cm] of the aorta. Both blood pressure and peripheral pulse on the arm and the legs returned to normal postoperatively in all patients.

• Archives of Plastic Surgery
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• 제39권3호
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• pp.216-221
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• 2012

Background : Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Methods : Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Results : Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. Conclusions : The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

• 한국전문물리치료학회지
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• 제16권1호
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• pp.1-9
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• 2009

An abdominal drawing-in maneuver (ADIM) with a pressure biofeedback unit can be used to prevent excessive lumbar lordosis during bridging exercise. Therefore, in this research, the effects of an ADIM on lumbar lordosis and lower extremity muscle activity during bridging exercise were investigated in thirty healthy adults. Surface electromyography (EMG) and VICON system were used to collect kinematic data and muscle activity, respectively. A paired t-test was used to determine a statistical significance. The results showed as follows: (1) When performing bridging exercise with an ADIM, the height of the anterior superior iliac spine and greater trochanter decreased significantly (p<.05). (2) When performing bridging exercise with an ADIM, the trunk extension angle and pelvic angle increased significantly (p<.05). (3) When performing bridging exercise with an ADIM, the EMG signal amplitude increased significantly in the rectus abdominis, internal oblique abdominis, external oblique abdominis, medial hamstring, and lateral hamstring (p<.05). (4) When performing bridging exercise with an ADIM, the EMG signal amplitude decreased significantly in the erector spinae (p<.05). From the result of this research, an ADIM trained with pressure biofeedback unit during bridging exercise is effective to prevent excessive contraction of erector spinae, to limit excessive motion of pelvis from sagittal plane and to increase muscle activity of abdominal muscles and hamstring muscle.

• 한국전산구조공학회논문집
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• 제25권3호
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• pp.219-226
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• 2012

기둥은 건물에서 하중을 지지하는 중요한 구성요소이므로 기둥의 손상 또는 파괴는 건물의 연쇄붕괴의 원인이 된다. 특히 폭발하중에 의한 기둥의 거동평가는 연쇄붕괴 방지에 있어 중요한 요소이다. 본 논문에서는 축하중을 받고 있는 기둥이 폭발하중을 받을 때의 거동과 폭발 저항성능을 평가하였다. 이를 위해 동일단면적과 비슷한 철근비를 가지는 기둥에서 주 철근의 개수를 달리하여 각 변수에 따른 폭발하중에 대한 폭발 저항성능을 평가하였다. 또한, 동일한 성능을 지니는 기둥에서 단면비를 달리하여 기둥의 폭발 저항성능을 비교하였다. 해석결과, 폭발 직후 충격량에 대한 수직 변형률은 철근의 개수 및 단면비에 영향을 받지 않는 것으로 나타났다. 그러나 수평변형의 경우 폭발압력을 받는 면의 철근 개수가 증가함에 따라 기둥의 저항성능이 증가하는 것으로 나타났다. 또한, 기둥 단면의 단면 2차모멘트가 클수록 폭발하중에 대한 저항 성능 및 복원력이 더 큰 것을 확인하였다.