• Archives of Plastic Surgery
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• 제39권6호
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• pp.636-636
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• 2012

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.28-33
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• 2001

The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.722-727
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• 2014

Background Perineal reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes following pelvic exenteration between cases with and without a VRAM flap. In this study, we aimed to compare the complications and the outcomes following pelvic exenteration with or without VRAM flap coverage. Methods We retrospectively reviewed the cases of nine patients for whom transpelvic VRAM flaps were created following pelvic exenteration due to pelvic malignancy. The complications and outcomes in these patients were compared with those of another nine patients who did not undergo such reconstruction. Results Flap reconstruction was successful in eight cases, with minor complications such as wound infection and dehiscence. In all cases in the reconstructed group (n=9), structural integrity was maintained and major complications including bowel obstruction and infection were prevented by obliterating the pelvic dead space. In contrast, in the control group (n=9), peritonitis and bowel obstruction occurred in 1 case (11%). Conclusions Despite the possibility of flap failure and minor complications, a VRAM flap can result in adequate perineal reconstruction to prevent major complications of pelvic exenteration.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.803-807
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• 2011

Purpose: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. Methods: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. Results: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft (8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients (8.50). Conclusion: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.

• The Journal of Korean Physical Therapy
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• 제29권3호
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• pp.128-134
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• 2017

Purpose: The purpose of this study is to investigate the effects of healthy persons performing a plank exercise with hip abduction and use of sling on trunk muscle activity. Methods: Twenty-three subjects participated in this study. Muscle activities of the multifidus, rectus abdominis, external oblique and internal oblique were assessed with electromyography (EMG) while the subjects performed 6 various types of plank exercises in random order. Results: There was a significant difference in multifidus and internal oblique on the supported side and the multifidus, external oblique, and internal oblique on the elevated side (p<0.05), and differences in plank methods were significantly higher in the multifidus, rectus abdominis, external oblique, internal oblique of the supported side and the rectus abdominis, external oblique and internal oblique on the elevated side (p<0.05). In addition, post-hoc analysis of the various plank methods showed that muscle activity was significantly higher during the general plank exercise compared with the knee-supported-in-sling plank exercises (p<0.05), and was significantly higher with the ankle-supported-in-sling plank exercises compared with the general plank exercise. Conclusion: There was greater trunk muscle activity with plank exercises performed with the ankle-supported-in-sling and hip abduction plank exercises compared with the general or knee-supported-in-sling plank exercises. Through this study, various plank exercises have been discovered that can be selected at different intensities for core muscle training purposes based on trunk muscle strength.

• Physical Therapy Rehabilitation Science
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• 제5권1호
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• pp.29-33
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• 2016

Objective: This study compared the muscle activities of the erector spinae (ES), the external oblique (EO), and the rectus abdominis (RA) on three different surfaces. The purpose of this study was to determine which surface induces the highest muscle activity during the plank exercises. The information from this study can be used to recommend plank exercises to athletes and patients with weak core muscles. Design: Cross-sectional study. Methods: The subjects include 20 adult males attending S University in Seoul. Participants completed each plank exercise on three different surfaces. To measure muscle activities, researchers used the values from electromyography. The measurement excluded the initial two and final two seconds and collected information on the RA, EO, and ES in each posture of each subject. Results: The left external oblique showed significant differences between the plank position on stable ground (ST) and the plank position using a suspension device (SL) (p<0.05) and between the plank position on the unstable ground (US) and SL (p<0.05). The right rectus abdominis and left rectus abdominis displayed statistically significant differences between the ST and the US (p<0.05) and between the ST and the SL (p<0.05). The right erector spinae had a statistically significant difference between ST and US (p<0.05). Conclusions: The plank exercise strengthens the core muscles effectively, and muscle activity is related to the posture of the exercise and the location of the muscle. These results suggest that plank exercises improve muscle activities. Additionally, plank exercises can be applied to general medical care.

• Physical Therapy Rehabilitation Science
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• 제9권3호
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• pp.197-200
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• 2020

Objective: The purpose of this study was to develop and investigate the feasibility of a sit-to-stand assistive chair using a pneumatic cylinder. Design: Cross-sectional study. Methods: The sit-to-stand assistive chair was developed to assist the sit-to-stand movement by rising up of the chair by a pneumatic cylinder. After the user is seated on the chair, if the pneumatic cylinder pulls the seat plate when standing up, the spring of the pneumatic cylinder, which has been stretched, assists in rising the rear end of the seat plate so that the user can stand conveniently and comfortably. A feasibility test was performed in 10 heathy adults. The electromyographic muscle activation of the trunk and lower extremity muscles was analyzed, which included the erector spinae, rectus abdominis, quadriceps, tibialis anterior, gastrocnemius when standing up from sitting using the developed chair and standing up without using the developed chair. Results: As a result, the sit-to-stand assistive chair using a pneumatic cylinder was developed. In the feasibility test, the use of the developed chair had a decrease in rectus abdominis, quadriceps, tibialis anterior activation compared to those who did not use the device in the healthy adults. Conclusions: The sit-to-stand assistive chair using a pneumatic cylinder may be helpful to reduce the activation of the rectus abdominis, quadriceps, tibialis anterior muscles when performing a sit-to-stand movement. Through the results, the efficacy of the sit-to-stand assistive chair can be confirmed. In the future, further studies are warranted to investigate for the safety and efficacy of its use in the elderly population or those who are disabled.

• 대한물리의학회지
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• 제10권3호
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• pp.95-100
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• 2015

PURPOSE: The purpose of this study is to investigate the effects of the angles of the knee and heel-off on the muscle activity during a bridge exercise. METHODS: 15 healthy adult men and women with the balance ability and joint working range required for performing a bridge exercise participated in this study, in which $120^{\circ}$, $90^{\circ}$ and $60^{\circ}$ angles of the knee-flexion and heel-off were applied during the bridge exercise. RESULTS: Our data showed that there were significant differences in muscle activities of elector spinae and rectus abdominis when $120^{\circ}$ and $60^{\circ}$ angles of the knee were applied, of internal oblique when $120^{\circ}$ and $60^{\circ}$ were applied, and external oblique when $90^{\circ}$ and $60^{\circ}$ were applied. When heel-off was applied, there were significant differences in muscle activities of elector spinae and rectus abdominis when $120^{\circ}$ and $60^{\circ}$ were applied, of internal oblique when $120^{\circ}$ and $60^{\circ}$ were applied, and external oblique when $90^{\circ}$ and $60^{\circ}$ were applied. CONCLUSION: In this study on an application of heel-off to the bridge exercise, we showed that the effect of the angles of the knee on the muscle activities of elector spinae, rectus abdominis, internal oblique and external oblique were all similar to the regular bridge exercise, but overall muscle activities were increased with heel-off when compared with the regular bridge exercise.

• The Journal of Korean Physical Therapy
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• 제25권3호
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• pp.149-154
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• 2013

Purpose: Spinal instability due to weakness of abdominal muscles is one of the major causes that induces low back pain (LBP). The purpose of this study was to investigate any differences in abdominal muscle activity during curl up, roll out, and jack knife exercises using a swiss-ball or sling. Methods: Twenty healthy subjects were randomly assigned into either a swiss-ball exercise group (SBEG) or a sling exercise group (SEG). Subjects performed curl up, roll out and jack knife exercises using the swiss ball or sling. Activity of abdominal muscles (rectus abdominis and external oblique muscle) was assessed using surface EMG and normalized maximal voluntary isometric contraction (MVIC). The significance of differences between the sling exercise group and the swiss-ball exercise group was evaluated by the independent t-test. Results: These Results indicated that activities of rectus abdominis on right and left of the SEG during the curl up exercise were significantly greater than the SBEG. During the roll out exercise, activity of the abdominal muscle was not significantly different between the SEG and SBEG. In addition, during the jack knife exercise, activities of the right rectus abdominis and left external oblique muscle in the SEG were significantly greater than the SBEG. Conclusion: In conclusion, activity of the abdominal muscles was maximized when curl up and jack knife exercise were performed using the sling rather than the swiss-ball. Therefore, if increased activation of the abdominal muscle is the goal of an exercise program, curl up and jack knife exercises may be useful.