• Archives of Reconstructive Microsurgery
• /
• v.6 no.1
• /
• pp.56-62
• /
• 1997

Latissimus dorsi(LD) muscle is the largest transplantable block of vascularized tissue. Since LD free flap was introduced in 1970's, this flap has been widely used for the reconstruction of large soft tissue defect of the limb. From 1981 to 1996, we had experienced 37 cases of LD free flap. Serratus anterior muscle was combined with LD in three of them whose defects were very large. The average age of the patients was 31 years(range : 4-74 years), and thirty one patients were male. Trauma was cause of the defect in every case. For the recipient sites, the foot and ankle was the most common(22 cases); and the knee and lower leg(11 cases), the elbow and forearm(2 cases), the hand(2 cases) were the next. The duration of follow-up was averaged as 16 months(range: 6 months-12 years). Thirty one cases(84%) out of 37 were successful transplantations. In one case the failure of the flap was due to heart attack and subsequent death of the patient. One failure was caused by sudden violent seizure of the patient who had organic brain damage. Immediate reexploration of the flap was performed in 4 patients, and the flap survived in three of them. There was one necrosis of the grafted split-thickness skin on the survived LD flap. LD free flap was considered as one of the good methods, for the reconstruction of the large soft tissue defect of the limb.

• Journal of the Korean Applied Science and Technology
• /
• v.37 no.1
• /
• pp.1-6
• /
• 2020

The purpose of this study was to investigate the effects of sling and vibrator application of knee push-up plus motion on trunk muscle activities. Ten healthy adult males(age, 23.00±0.45 years; height, 176.60±1.64 cm; body mass, 67.50±1.22 kg; and BMI, 21.65±0.34 kg/㎡) were participated in this study as subjects. Three types' knee push-up plus motions were performed(basic knee push-up plus motion, BKPP; knee push-up plus motion with sling, KPPS; knee push-up plus motion with vibration, KPPV). We measured the right side's trunk muscle activities of the upper trapezius(UT), pectoralis major(PM), serratus anterior(SA), rectus abdominis(RA), and external oblique(EO). The research findings were as follows. UT, PM, SA, RA, and EO muscle activities were greatest during KPPV(p<.001). These results are expected to serve as reference materials for knee push-up plus motion applications in training programs for trunk muscle strengthening.

• Archives of Plastic Surgery
• /
• v.36 no.6
• /
• pp.755-760
• /
• 2009

Purpose: Breast surgeons usually insert tissue expander or implant beneath the subpectoral - subglandular dual plane in breast reconstruction. But sometimes it happens unsatisfactory lower pole fullness, asymmetric inframammary fold and breast shape because there is implant migration due to the pectoralis major muscle contraction and gravity. To solve all the problem like these, we introduce implant breast reconstruction using AlloDerm$^{(R)}$(LifeCell Corp., Branchburg, N.J.) sling. Methods: The AlloDerm$^{(R)}$ sling was used in 13 patients and 18 breasts for implant breast reconstruction. After mastectomy, costal and lower sternal insertion of pectoralis major muscle was detached. Rehydrated AlloDerm$^{(R)}$ was sutured to the chest wall and serratus anterior fascia at the level of inframammary fold downward and to lower border of the pectoralis major muscle upward like crescent shape with tension free technique after implant insertion into the subpectoral - subAlloDerm dual pocket. Results: We make satisfactory lower pole fullness, symmetric inframammary fold and breast shape. In conclusion, patients obtain relatively natural breast shape. There was no complication except one case of capsular contracture and one case of breast cellulitis. Conclusion: Implant breast reconstruction using AlloDerm$^{(R)}$ sling makes easy to get natural breast shape through satisfactory lower pole fullness, symmetric inframammary fold and implant positioning.

• Physical Therapy Korea
• /
• v.22 no.4
• /
• pp.17-26
• /
• 2015

The purpose of this study was to investigate the effects of visual electromyography (EMG) biofeedback on the EMG activity of the lower trapezius (LT), serratus anterior (SA), and upper trapezius (UT) muscles, the LT/UT and SA/UT EMG activity ratios, and the scapular upward rotation angle during scapular posterior tilting exercise (SPTE). Twenty-four subjects with round-shoulder posture participated in this study. The EMG activities of the LT, SA, and UT were collected during SPTE both without and with visual EMG biofeedback. The scapular upward rotation angle was measured at the baseline, after SPTE without visual EMG biofeedback, and after SPTE with visual EMG biofeedback. The LT, SA, and UT EMG activities, and the LT/UT and SA/UT EMG activity ratios were analyzed by paired t-test. The scapular upward rotation angle was statistically analyzed using one-way repeated analysis of variance. If a significant difference was found, a Bonferroni correction was performed (p=.05/3=.017). The EMG activities of LT and SA significantly increased, and the EMG activity of UT significantly decreased during SPTE with visual EMG biofeedback compared to SPTE without visual EMG biofeedback (p<.05). In addition, the LT/UT and SA/UT EMG activity ratios significantly increased during SPTE with visual EMG biofeedback compared to SPTE without visual EMG biofeedback (p<.05). Significant increases were found in the scapular upward rotation angle after SPTE without and with visual EMG biofeedback compared to baseline (p<.017), and no significant differences were observed in the scapular upward rotation angle between SPTE without and with visual EMG biofeedback. In conclusion, SPTE using visual EMG biofeedback may be an effective method for increasing LT and SA activities while reducing UT activity.

• Journal of International Academy of Physical Therapy Research
• /
• v.11 no.1
• /
• pp.1960-1968
• /
• 2020

Background: The alignment of the neck and shoulder is important in people with forward head posture. However, previous studies have mainly conducted fragmentary studies on the neck and shoulders, and studies on the combined movement of the neck and shoulders are incomplete. Objective: To investigate the effects of 6 week dynamic exercise program using Thera-band on craniovertebral angle (CVA) in adults with forward head posture. Design: Quasi-experimental study. Methods: The study was conducted on 24 adults with forward head posture and experimented with neck and shoulder exercises and divided them into groups of neck exercises, shoulder exercises, and neck and shoulder exercises to measure CVA values before and after the experiment. The neck exercise program included flexion and extension muscles of the neck and shoulder exercises included dynamic exercise of the upper extremities such as the trapezius muscles and serratus anterior muscle. The CVA results were measured using PA200. Results: Following the interventions, neck exercise group showed significant improvement in CVA (P<.05), but shoulder exercise group and combined exercise group did not show any significant results (P>.05). However, both groups showed some positive results. Significant differences were seen in the comparisons between the three groups (P<.05), and the results of the post-hoc test showed significant differences in neck exercise group and shoulder exercise, neck exercise and combine exercise group. Conclusion: This study suggested that the Thera-band neck exercise is beneficial for foward head posture patients and is expected to be used in clinical trials.

• The Journal of Korean Physical Therapy
• /
• v.31 no.3
• /
• pp.151-156
• /
• 2019

Purpose: This study aimed to investigate the immediate effects of posture correction and real-time visual feedback using a video display on muscle activity and change of head position during overhead arm lift test in individuals with forward head posture. Methods: Fifteen subjects with forward head posture and fifteen normal subjects who volunteered were included in this study. During both groups performed the overhead arm lift test, the muscle activity of the upper trapezius, serratus anterior, sternocleidomastoid, and lower trapezius muscle were measured using electromyography, and head position change was measured using photographs. Then, forward head posture group was asked to perform overhead arm lift test again after posture correction and real-time visual feedback using a video display respectively. One-way analysis of variance (ANOVA) was used to analyze four conditions: pre-test, posture correction, real-time visual feedback, and the control group. Results: The upper trapezius and lower trapezius muscle activity significantly decreased posture correction, real-time visual feedback, and control group than pre-test of forward head posture group (p<0.05). The sternocleidomastoid muscle significantly decreased real-time visual feedback and control group than pre-test of forward head posture group. Head position change significantly decreased three conditions than pre-test of forward head posture group and real-time visual feedback and control group significantly decreased than posture correction. Conclusion: This study recommend for maintaining cervical stability during the overhead arm lift test, postural control using real-time visual feedback is more effective in subjects with forward head posture.

• Archives of Plastic Surgery
• /
• v.46 no.4
• /
• pp.365-370
• /
• 2019

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed-correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.

• PNF and Movement
• /
• v.17 no.1
• /
• pp.11-18
• /
• 2019

Purpose: This study verifies the muscle activity around the amputation site during proprioceptive neuromuscular facilitation (PNF) pattern exercise for the upper extremities on the non-amputated part in upper extremity amputees and provides basic data on effective exercise around an amputation site. Methods: Manual resistance was applied to the PNF upper extremity pattern of the non-amputated part to generate muscle activity around the amputation site. The resistance was adjusted to an intensity that could cause maximal isometric contraction. The muscle activity of the amputation site and the non-amputated part was measured using a surface electromyogram for the upper trapezius, middle trapezius, infraspinatus, serratus anterior, and pectoralis major. Results: During the scapular exercise in the painless range, the amputated side showed significantly lower muscle activity and a lower muscle contraction ratio compared with the non-amputated side. During the PNF pattern exercise in the painless range, the amputated side showed lower muscle activity and a lower muscle contraction ratio compared with the non-amputated side. When the direct scapular exercise of the amputated side was compared with the PNF pattern exercise of the non-amputated side, their muscle contraction ratios were similar. Conclusion: This study confirmed the effectiveness of the PNF pattern exercise of the non-amputated part as a way to indirectly train the injured site with no pain for rehabilitation of patients with serious body injuries, such as amputation. It is necessary to develop effective exercise programs for the rehabilitation of the amputation site based on the results of this study.

• Physical Therapy Korea
• /
• v.26 no.2
• /
• pp.61-68
• /
• 2019

Background: Forward head posture (FHP) is a postural alignment of the cervical vertebrae that leads to increased gravitational load on cervical segmental motions. The overhead arm lift test assesses the ability to actively dissociate and control low cervical flexion and move the shoulders through overhead flexion. Objects: The purpose of this study was to explore muscle activities in the upper trapezius (UT), serratus anterior (SA), sternocleidomastoid (SCM), and lower trapezius (LT) alongside changes in head position during the overhead arm lift test in individuals with FHP. Methods: Fifteen subjects with forward head posture and fifteen subjects with normal subjcects were enrolled in this study. The patients performed the overhead arm lift test, and muscle activities of the UT, SCM, SA, and LT were measured using surface electromyography and by evaluating changes in head position. Independent t-tests were used to detect significant differences between the two groups and Cohen's d was calculated to measure the size of the mean difference between the groups. Results: The FHP group demonstrated significantly increased muscle activity of the UT ($32.46{\pm}7.64$), SCM ($12.79{\pm}4.01$), and LT ($45.65{\pm}10.52$) and significantly decreased activity in the SA ($26.65{\pm}6.15$) than the normal group. The change in head position was significantly higher in the FHP group ($6.66{\pm}2.08$) than the normal group. Effect sizes for all parameters assessed were large between the two groups. Conclusion: The subjects with excessive FHP displayed were unable to fix their heads in position during the overhead arm lift test. The overhead arm lift test can thus be used in clinical settings to confirm control of the neck in these subjects.

• PNF and Movement
• /
• v.11 no.2
• /
• pp.49-56
• /
• 2013

Purpose : The purpose of this study was compared for rounded scapular between strechting on pectoralis minoor and strengthening on scapular stabilizer muscles. Methods : The main laboratory had an experiment of the exercise for rounded shoulder posture with 30 patients on a pectoralis minor stretching and scapula to stabilize the elastic band to divide into two groups in this study which were conducted. Results : Acromial height measured from changes of the rounded shoulder posture changes before and after workouts; stretching before exercise in the exercise group is from $94.19{\pm}3.47$ to after result of $94.84{\pm}3.19$, and the after exercise of an elastic band pre-exercise in the exercise group is from $93.60{\pm}3.42$ to $88.68{\pm}3.49$, dividing into two groups, which increased significantly. Compared to an acromial height variation results before and after workouts; stretching exercise group made $3.07{\pm}1.43$, $4.91{\pm}2.24$ and elastic band exercise group, $4.91{\pm}2.24$, which shows the difference between the two groups and was not statistically significant. Conclusion : Against a pectoralis minor that cause the findings of this study, RSP proximately shows serratus anterior and the strengthening of trapezius by exercises of the shoulder peaks which decrease in height arbitration scheme of a pectoralis minor stretching effect as shown. Therefore, it is expected RSP patients in clinical intervention methods combined with stretching exercises strengthens muscles against an elastic band exercise effective.