• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.26-31
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• 2007

Background and Objectives：Microvascular free flap reconstruction has been revolutionized in last two decades, and became a standard option in the reconstruction of head and neck defects. We intended to review our experiences of 51 microvascular free flap for head and neck defects during 5-year period and to analyze the types of flaps according to primary sites, success and complication rates. Subjects and Methods：From Oct. 2001 through Dec. 2005, fifty one free flap reconstructions were performed in forty nine patients at ENT department of Soonchunhyang university bucheon hospital. Primary sites, pathology, T-stage, operative time, time interval of oral feeding, and various reconstructive factors such as recipient and donor vessels, free flap related complications, failure rates and salvage rates were retrospectively analyzed. The relation between complication rates and preoperative risk factors were statistically analyzed. Results：Methods of reconstruction were radial forearm free flap(RFFF)(n=28, 54.9%), anterolateral thigh free flaps(n=9, ALTFF)(17.6%), rectus abdominis free flap(n=7, RAFF)(13.7%), jejunal free flap(n=5, JFF)(9.8%), and miscellanous(n=2, 4.0%) in order. In free flap related complications, failure of free flap occurred in seven cases(13.7%) and pharyngocutaneous fistula occurred in five cases(9.8%) among fifty one free flaps. The overall success rate of free flaps was 86.3%. Salvage of free flaps was possible only one among eight cases(12.5%). In positive preoperative risk factor groups, failure of free flap was higher than in negative risk factor group. However, it was not statistically significant. Conclusion：We confirmed that free flap reconstructions are highly versatile and reliable options for use in the reconstruction of various soft tissue defects of the head and neck. Free flaps have gained great popularity given its versatility, ability for a two-team approach, and minimal donor site morbidity. However, complications related to microvascular surgery may be overcome by increased surgical experience and by intensive flap monitoring in early postoperative period.

• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.59-64
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• 1997

The aims of free tissue transplantation to the injured foot are to cover the exposed blood vessels, nerves, muscles, tendons and bones, to clear up infection, to lessen the morbidity, to shorten the hospitalization, and to prepare for further surgical procedures when no local or transpositioning flaps are available. Authors have carried out free flap transplantation in 13 cases of crushing injury, osteomyelitis and electrical burn in the foot at Chonbuk National University Hospital from June 1992 through May 1996. The results were as follows : 1. 9 cases of 13 (69%) were sustained from the traffic accident. 2. The dorsalis pedis free flap transplantation has been performed most frequently in 5 cases (38.5%), followed gracilis muscle flap in 4 cases(30.7%), rectus abdominis muscle flap in 2 cases(15.4%), latissimus dorsi muscle flap and upper arm flap in 1 each. 3. 6 muscle flaps were covered with split thickness skin graft 20 days after microsurgical anastomosis. 4. All of 13 cases were survived after microsurgical procedure and showed excellent coverage in the foot.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.894-898
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• 2011

Purpose: Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. Methods: A 24-year-old male patient had $13.0{\times}7.0{\times}14.0$ cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0 cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. $24{\times}25$ cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with $21{\times}10$ cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries. Results: Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable. Conclusion: The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.428-434
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• 2020

Background Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes. Methods A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision-making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction. Results Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group. Conclusions Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.228-234
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• 2011

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma, deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.

• Korean Journal of Applied Biomechanics
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• v.27 no.4
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• pp.247-255
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• 2017

Objective: The purpose of this study was to investigate the maximum core muscle activation angle according to core-strengthening exercises. Method: Twenty-six young female football players (age: $17.84{\pm}0.80years$, height: $163.08{\pm}5.25cm$, weight: $54.96{\pm}7.41kg$) registered in the Korea Football Association from D High School located in Seoul were the subjects of this research. An electromyogram (Noraxon, USA) was used for monitoring the maximum core muscle contraction activity. Results: The angle for the maximum core muscle strength per core exercise and muscle was the smallest for the upper rectus abdominis in the windshield wiper exercise. The angle of the vastus medialis was significantly the largest. The range of angles at which the maximum strength was observed for each core exercise were as follows: 1) abdominal flutter kicks ($11{\sim}40^{\circ}$), 2) leg raises ($21{\sim}34^{\circ}$), 3) scissors ($45{\sim}66^{\circ}$), 4) knee to elbow sit-ups ($42{\sim}64^{\circ}$), 5) reverse crunches ($9{\sim}40^{\circ}$), 6) butt-ups ($24{\sim}32^{\circ}$), 7) V sit-ups ($5{\sim}24^{\circ}$), 8) windshield wipers ($11{\sim}20^{\circ}$), 9) bird dog ($11{\sim}18^{\circ}$), and 10) raised leg plank ($38{\sim}50^{\circ}$). Conclusion: Four kinds of motion could be classified according to the range of angles at which the core muscles were maximally activated. The first group involves the range of motion that gives the maximum muscle strength when the lower extremity and ground angle was between $5^{\circ}$ and $24^{\circ}$, such as the V sit-ups, windshield wipers, and bird dog. The second group comprised the flutter kicks and reverse crunches at an angle between $9^{\circ}$ and $40^{\circ}$. The third group comprised the leg raise and butt-up exercises at an angle between $21^{\circ}$ and $34^{\circ}$. The fourth group included the scissors, knee to elbow sit-ups, and raised leg plank at an angle between $38^{\circ}$ and $66^{\circ}$. These results may be useful as basic data for core movement and core muscle training according to the purpose of exercise.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.3
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• pp.181-188
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• 2020

Purpose : The purpose of this study is to compare the effects on abdominal muscle thickness and breathing by applying trunk strength exercise and deep stabilization exercise along with breathing exercise, which is the main respiratory muscle during breathing, to present an efficient exercise method with diaphragm breathing. Methods : This study was performed on normal 6 females and 14 males subjects. They were divided into 2 groups which trunk strength exercise and deep stabilization exercise group. The trunk strength exercise group (TSE) attended prone press-up, crunch and pelvic tiling. The deep stabilization exercise group (DSE) attended abdominal drawing, horizontal side-support and bridging exercise. Breathing exercise was performed for each set break time for 1 minute. Results : First, in the comparison of the change in the thickness of the abdominal muscle between the trunk strength training group and the deep stabilization group before and after exercise, there was a statistically significant difference in the comparison of transverse abdominis (TrA), rectus femoris (RF), external oblique (EO), internal oblique (IO) (p<.05). However, there was no significant difference in any comparison between groups (p>.05). Second, in the comparison of changes in respiratory function between the trunk strength exercise group and the deep stabilization exercise group before and after exercise, there were statistically significant differences in the exerted forced vital capacity (FVC), forced expiratory volume at one second (FEV₁), peak expiratory flow (PEF) in the comparison before and after the experiment (p<.05). However, there was no significant difference in any comparison between groups (p>.05). Conclusion : As a result of this study, it can be said that both trunk strength exercises and deep stabilization exercises along with diaphragm breathing are exercises that strengthen deep and superficial muscles, and have a positive effect on breathing function as well as muscle strength. However, it is not known which exercise was more effective, and because it was combined with breathing exercise, the interference effect appeared.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.176-183
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• 1999

Chronic osteomyelitis have been treated with wound dressing and antibiotics therapy often results in healing but foul odor pus discharges from the fibrotic soft tissues reactivates and requires appropriate control of the infection. Debridement of the wound, curettage and sequestrectomy, bone graft and immediate free flap transplantation is the curative protocol for the chronic osteomyelitis in the lower extremity. Authors have treated 7 cases of chronic osteomyelitis in the lower extremity with microsurgical free tissue transplantation at Department of Orthopedic Surgery, Chonbuk National University Hospital from December 1993 through February 1998. The results are as follows. 1. The chronic osteomyelitis occurred in tibial shaft in 4 cases, in calcaneus 2 cases and in femur 1 case. 2. Duration of the chronic osteomyelitis was at average 31.6 years. 3. Squamous cell carcinoma in the surrounding fibrotic tissue was biopsied in 1 case. 4. 4 cases had no trauma and occurred through hematogenous infection and 3 cases had fracture trauma. 5. Wound debridement and immediate free muscle transplantation had done in 5 cases and wound debridement, sequestrectomy and immediate free muscle transplantation in 2 cases. 6. Rectus abdominis muscle transplantation had peformed in 4 cases(57.1%), latissimus dorsi mucle 1 case(14.3%), latissimus dorsi myocutaneous 1 case(14.3%) and gracilis 1 case (14.3%). 6 cases of 7 were success(85.7%). 7. 1 case of failed latissimus dorsi musculocutaneous flap in thigh had done above knee amputation and 1 case of chronic posttraumatic osteoarthritis of the ankle joint had done below knee amputation at other hospital.

• Journal of Acupuncture Research
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• v.18 no.6
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• pp.1-13
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• 2001

Objective : To broaden understanding about relationship between Meridian Tendino-musculature and muscles in a lumbar area and to evaluate the effect of Meridian Tendino-musculature acupuncture and release therapy on acute lumbar sprain. Materials and Methods : From Oct. 1st, 2000 to Mar. 31th, 2001, 692 outpatient's chart of Kyung Won University Hospital were reviewed. Out of them, 39 outpatients were selected. they had low back pain, were diagnosed with acute lumbar sprain, showed only straightened curvature on lateral view of lumbar spine X-ray and get the Tendino-musculature acupuncture and release therapy. Results : 1. On patients' first visit, 72% had GrIII and Gr.IV predominantly. 2. Major muscles related with low back pain were divided into two groups. One was Quadratus lumborum group and the other was Rectus abdominis group. In the correlation with Meridian Tendino-musculature, the former was mainly related with Chok-taeyang(B) and slightly related with Chok-soyang(G), Chok-taeum(SP), the latter was mainly related with Chok-taeyum(SP), Chok-yangmyong(S) and slightly related with Chok-taeyang(B), Chok-soyang(G). 3. In the evaluation of treatment effect, Exellent was 27(69%), Good was 10(6%), Fair was 2(5%) and Bad was 0(0%). Fair rate reached 100% eventually. 4. Most of Gr.Ⅲ, Gr.Ⅳ patients who had severe conditions that almost every R.O.M. was limited and Milgram test positive was shown on the physical examination, were fully recovered and lived normal daily life without admission by Meridian Tendino-musculature acupuncture and release therapy within 3 to 5, 4 to 7 days, respectively, since they had started to get their outpatient treatment. 5. Two patients was troubled with pain induced, by twitching response and acupuncure stimuli, which lasted around acupunctured muscle for about a day after treatment, so they coudn't endure the pain and quitted treatment in spite of Fair condition. conclusion : Meridian Tendino-musculature acupuncture and release therapy was found to be helpful to patients who wish to recover from their back pain induced by acute lumbar sprain as soon as possible, but the treatment actually had some problems to be overcome such as pain during or after the treatment. therefor, in order to make this treatment method more available, we should pay more attention to improving treatment appliance and acupuncture technique.