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

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.2
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• pp.67-75
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• 2022

Background: Scapular winging is a rare disorder that is commonly caused by nerve damage of the dorsal scapular nerve, spinal accessory nerve, or the long thoracic nerve. This affects the scapulohumeral rhythm which may cause abnormal kinetic motion of the shoulder. The purpose of this case report is to describe a self-exercise oriented management incorporating shoulder strengthening to reduce symptoms in a shoulder pain patient with winging scapular. Methods: A 45 year old male patient complained of pain in his both shoulders without any trauma. Shoulders were treated with steroid injections for supraspinatus tendonitis, but although pain improved to some extent, pain and disability continued for 3 months. Both shoulders had pain, decreased active range of motions, muscles weakness, and scapular winging. The patient underwent 9 interventional sessions over 3 months and was managed mainly by self-exercise. The intervention method involved push up plus, sling, muscle strengthening, and stabilization exercises. Loads were increased as symptoms improved. Results: Clinical outcomes were measured at every session. Pain in both shoulders reduced to 0 on a numerical pain rate scale by the 4th session, and the active range of motion was fully recovered. During the 9th session, the strength of the serratus anterior had improved from grade P to G on the right side and grade G to N grade on the left. Conclusion: In this case study, the self-exercise program was effective in reducing pain, increasing active range of motion, and improving muscle strength in subjects with scapular winging.

• Physical Therapy Korea
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• v.27 no.2
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• pp.93-101
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• 2020

Background: For performing various movements well, cooperation between the muscles around the scapula and shoulder has been emphasized. Taping has been widely used clinically as a helpful adjunct to other physiotherapy methods for shoulder pathology and dysfunction treatment. Previous studies have evaluated the effect of taping techniques using dynamic tapes on shoulder function and pain. However, no study investigated the electromyographic (EMG) changes in the shoulder muscles. Objects: This study aimed to investigate the effect of the upper limb offload taping technique using a dynamic tape on EMG activities of the upper trapezius (UT), lower trapezius, serratus anterior (SA), and middle deltoid (MD) muscles during scaption plane elevation. Methods: A total of 26 healthy subjects (19.85 ± 6.40 years, male = 20) volunteered to participate in this study. The subjects were instructed to perform scaption elevation with and without dynamic taping on the shoulder. Shoulder elevation strength tests were performed at 100%, 75%, 50%, and 25%, for the maximal isometric contraction force. Results: There were statistically significant interaction effects between the taping application and shoulder scaption elevation force in EMG activities in the UT (p < 0.05) and MD (p < 0.05). EMG activities in the UT showed significant increases in 50%RVC (reference voluntary contraction, p < 0.05) and 25%RVC (p < 0.01). Furthermore, the EMG activity of the SA significantly increased in 50%RVC (p < 0.01) and 25%RVC (p < 0.01) after dynamic taping. For the MD, the EMG activity level significantly decreased in 100%RVC (p < 0.05). Conclusion: These results indicated that upper limb offload dynamic taping application affects the muscle activities of some shoulder muscles depending on different scaption elevation strength levels. Therefore, we suggest that the upper limb offload dynamic taping can be applied to the shoulders when patients need middle deltoid inhibition or upper trapezius facilitation, such as patients with shoulder impingement syndrome.

• Archives of Plastic Surgery
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• v.41 no.1
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• pp.50-56
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• 2014

Background The aim of this study was to determine the efficacy of lateral intercostal artery perforator-based adipofascial free flaps for facial reconstruction in patients with facial soft tissue deficiency. Methods We conducted a retrospective study of five consecutive patients diagnosed with facial soft tissue deficiency who underwent operations between July 2006 and November 2011. Flap design included the area containing the perforators. A linear incision was made along the rib, which had the main intercostal pedicle. First, we dissected below Scarpa's fascia as the dorsal limit of the flap. Then, the adipofascial flap was elevated from the medial to the lateral side, including the perforator that pierces the serratus anterior muscle after emerging from the lateral intercostal artery. After confirming the location of the perforator, pedicle dissection was performed dorsally. Results Dominant perforators were located on the sixth to eighth intercostal space, and more than four perforators were found in fresh-cadaver angiography. In the clinical case series, the seventh or eighth intercostal artery perforators were used for the free flaps. The mean diameter of the pedicle artery was 1.36 mm, and the mean pedicle length was 61.4 mm. There was one case of partial fat necrosis. No severe complications occurred. Conclusions This is the first study of facial contour reconstruction using lateral intercostal artery perforator-based adipofascial free flaps. The use of this type of flap was effective and can be considered a good alternative for restoring facial symmetry in patients with severe facial soft tissue deficiency.

• Physical Therapy Korea
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• v.22 no.4
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• pp.17-26
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• 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
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• v.11 no.1
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• pp.1960-1968
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• 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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.4
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• pp.624-631
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• 2017

This study aimed to identify the effect of the push-up plus exercise with sling on the muscle activity and lung function in adults with forward head posture over a period of 8 weeks. A total of 16 adults with forward head posture were recruited. The participants were divided into two groups : control (n-=8) and experimental (n=8). From July 6 until Aug 28, 2015, the participants were instructed to perform the knee push-up plus exercise and knee push-up plus using sling exercise three times a week to begin with and progressing to three sets of push-ups on each occasion after 8 weeks. The participants in both groups showed an increase in their craniovertebral angle (both groups p<0.001) and a decrease in their crania rotation angle (control p<0.05, experimental p<0.001). The participants in both groups showed a decrease in their trapezius activity (both groups p<0.001), an increase in their serratus anterior and lower trapezius muscle activity (both groups p<0.001), (and an increase in their) lung function (control group p<0.01, experimental group p<0.001). These findings show that push-up plus exercise improves posture and increases activation of lung function, while the push-up plus exercise in the sling is more effective in improving the forward head posture. The push-up plus exercise in the sling was more effective in improving the forward head posture, but there was no significant difference in the lung function between the two groups. Therefore, the push-up plus exercise in the sling is recommended as an exercise that is effective for the improvement of the posture and lung function of persons with forward head posture.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.765-769
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• 2007

Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.55-61
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• 2009

Purpose: To analyze the clinical and radiologic results of the shoulder arthrodesis in brachial plexus injury patients with flail upper extremity. Material and Method: From Aug 1978 to April 2008, 29 shoulders in 29 patients with brachial plexus injury with shoulder fusion, we evaluated 20 shoulders in 20 patients, more than 1 year follow up. The average follow-up period was 6.45years (range: 1year~24years). There were 13 men and 7 women, and the mean age at the time of trauma was 32.0years(2~65 years). The type of injury was a motorcycle accident in 11 patients, in car accident in 5, pedestrian accident in 3, and fall from a height in 1. The lesion of injury was root and trunk in 1 patient, trunk and cord in 1, trunk in 18. Surgery was performed on the whole arm type paralysis in 12 patients, lower arm type paralysis in 8 patients. The preoperative visual analog scale score was 8.7(7~10). When the trapezius and serratus anterior muscle were in function, operation was performed. 18 patients were processed to the additional operation. Gracilis free flap in 6 patients, neurotization in 3, Steindler flexor plasty in 6, and tendon transfer in 3 were performed. Fixation was conducted with cancellous screws in 13 patients, Knoles pins in 5, and cancellous screws and Knoles pins in 2. The position of the arthrodesis at operation was $28.5^{\circ}$($20~45^{\circ}$) in abduction, $30.3^{\circ}$($20~45^{\circ}$) in flexion, and $30.8^{\circ}$($20~40^{\circ}$) in internal rotation. Result: The follow up visual analog scale score was 3.4(0~7). Postoperatively, shoulder spica cast was applied for 15.3weeks(8-20weeks). The median time to bony union was 17.7weeks(9~28weeks). Average range of motion was $32.0^{\circ}$($15~40^{\circ}$) of abduction, $24.0^{\circ}$($10~40^{\circ}$) of flexion, and $18.5^{\circ}$($10~30^{\circ}$)of internal rotation. Conclusion: The shoulder fusion in brachial plexus injury patients is one of the good methods to relieve pain, improve the function and stabilize the flail shoulder joint.