• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.68-73
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• 2004

Transverse rectus abdominis muscle (TRAM) free flap is widely used for breast reconstruction, however donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. For the purpose of minimizing donor-site morbidity, there has been a surge in interests in muscle sparing free TRAM flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. The purpose of this study is to investigate complication and morbidity after muscle sparing free TRAM flap. Between August, 1995 and May, 2003, there were 108 cases of muscle sparing free TRAM flap of breast reconstruction. There was no abdominal hernia. There were 4 cases of dog ear, 3 cases of marginal necrosis of apron flap, 2 cases of asymmetry of umbilicus. At 1 year after operation, most patients feel comfortness in physical exercise. Muscle sparing free TRAM flap provides ample amount of well vascularized soft tissue with small inclusion of rectus abdominis muscle and fascia. Also it minimizes donor-site morbidity with rapid recovery of abdominal strength.

• 한국철도학회:학술대회논문집
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• 한국철도학회 2008년도 춘계학술대회 논문집
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• pp.975-979
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• 2008

Since tram has the advantages to reduce construction cost of infrastructure, to improve accessibility of passengers, and to offer visual pleasures, nowadays, it is one of light rails attracting public attention. Tram can be classified into two groups, one is a conventional steel-wheeled type, and the other is a rubber-tired type (bi-modal tram). The bi-modal tram propelled by the serial CNG hybrid propulsion unit has been developing since 2003 in Korea, which can realize both scheduled operation of railway and route flexibility of bus. Because the bimodal will be operated on both railway mode and bus mode, however, specific criteria and regulations for its design, certification, construction, operation and maintenance have not been determined definitely yet. In consideration of mobility enhancement for the old and the handicapped, motor vehicle safety standard and urban transit (railway vehicle) safety standard, several design specifications were proposed for car body and interiors of the bimodal tram vehicle. The design specifications proposed in this paper can be expected to promote passengers' comfort and safety, operation efficiency of the bimodal tram.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.60-63
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• 2007

Purpose: Free transverse rectus abdominis musculocutaneous(TRAM) flap is one of the most popular methods of breast reconstruction. But if fat necrosis and fatty induration occur at the reconstructed breast, they can make the breast harder and make it difficult to differentiate a tumor recurrence from them. To expect and prevent these complications, we measured the pressure change of the superficial venous system whose congestion can be the cause of them. Methods: An intraoperative clinical study was done to compare venous pressure of superficial inferior epigastric vein(SIEV) before and after the elevation of free TRAM flap. Fourteen TRAM flaps were included and the pressures of SIEV were measured two times at the beginning of the elevation and just before the division of the inferior pedicle. Results: The venous pressure in free TRAM flap was significantly higher after the flap elevation at both contralateral side and ipsilateral(p=0.005 and p=0.026 respectively). The four cases with vertical scar shower significantly greater increase at contralateral side than ipsilateral side(p=0.020). Conclusion: Intraoperative venous pressure recording can be an objective data for evaluating the congestion of TRAM flap and can help to prevent the complications of fat necrosis and fatty induration with venous superdrainage.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.577-582
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• 2010

Purpose: When reconstruction for patients who have the large contralateral breast or a following large defect after mastectomy is required, conventional pedicled TRAM flap shows the unpredictable occurrence of fat necrosis and skin flap loss in a relatively high percentage due to insufficient blood supply. In an effort to obtain more stable TRAM flap blood circulation, we have performed a supercharged technique using deep inferior epigastric perforators (DIEP) with conventional pedicled TRAM flap. Methods: From September of 2006 to December of 2008, Fourteen supercharged TRAM flap were performed for breast reconstruction after modified radical mastectomy. The contralateral DIEP was anastomosed to the internal mammary vessels in contralateral pedicled TRAM flap or thoracodorsal vessels in ipsilateral pedicled TRAM flap. Nutrient vessels were selected by Multi-Detector Computed tomography (MD-CT) modalities. For the nutrient vessel, we used deep inferior epigastric vessels (DIEV) of the ipsilateral side in 8 patients, DIEV of the contralateral side in 6 patients. In addition, for the recipient vessel, we used thoracodorsal vessels in 8 patients, internal mammary vessels in 5 patients, intercostals artery perforators in 1 patient. Results: The mean age was 46.8 years and the average follow-up interval was 14 months. There were 11 immediate and 3 delayed breast reconstructions. Fat necrosis incidence rate in supercharged TRAM group was lower than in conventional TRAM flap group. There were no differences of the incidences of abdominal hernia in both groups. Conclusion: The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. The breast reconstruction with supercharged technique is reliable and valuable methods which provide sufficient soft tissue from abdomen without significant complications.

• 한국철도학회:학술대회논문집
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• 한국철도학회 2010년도 춘계학술대회 논문집
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• pp.241-248
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• 2010

A bimodal low-floor tram can provide the punctuality of trains and the flexibility of bus together to the passengers. Its propulsion system is a series hybrid type using a set of CNG engine generator and Li-polymer battery. This paper presents a development of the measurement equipment for fine-tuning of a series hybrid propulsion system of bimodal low-floor tram. Its configuration schemes are described and certified using the measurement data of bimodal low-floor tram.

• 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.

• 한국ITS학회 논문지
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• 제9권6호
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• pp.63-82
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• 2010

지속적인 도로 건설에도 불구하고 자동차의 급격한 증가와 주변 택지개발로 인해 고속도로 상습지정체가 나날이 심화되어 교통관리의 필요성과 운전자에 대한 교통정보제공 요구가 크게 부각되고 있다. 고속도로의 상습지정체를 해소하기 위해서는 혼잡의 원인과 유형, 특성에 따라 최적의 혼잡관리기법을 도출하고 사전 시행효과가 검토되어야하나, 기존의 교통분석 프로그램들은 국내 도로 및 교통조건, 교통류특성 등에 대한 반영 및 기 구축된 교통관리시스템(FTMS)과의 연계가 미흡하여, 효율적으로 고속도로 교통분석을 수행하기에는 시간적, 비용적으로 많은 제약이 따른다. 따라서 본 연구에서는 고속도로 교통관리시스템의 수집자료에 기반하여 체계적이고 과학적인 혼잡관리방법론을 적용하기 위해 한국형 교통분석 모형 및 프로그램(ExTRAM)을 개발하였다. VISSIM과의 비교결과, 정체에 대한 모사와 대안평가에서 ExTRAM의 결과가 다소 나은 것으로 평가되었다. ExTRAM에 대한 보다 엄밀한 검증을 위해 오산~수원 구간의 15분 집계간격의 평균통행시간(TCS데이터)을 이용한 한 달 동안의 장기간 테스트를 수행한 결과, 평균통행시간 오차가 2.48분이었고, 최대 및 최소 오차가 각각 15.02분 및 0.03분으로 나타나 ExTRAM의 교통분석 결과가 일정 수준의 정확도를 보이는 것을 확인할 수 있었다.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.187-191
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• 2013

Background Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group. Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared. Results Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001). Conclusions Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2008년도 학술대회 논문집 정보 및 제어부문
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• pp.450-451
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• 2008

The Bimodal tram is developed in KRRI (Korea Railroad Research Institute). This vehicle will be used in the public transportation system. The Bimodal tram has the advantages of both bus and train. Bus system has the advantages of flexibility of the routes delivering passengers to the destination and easy accessibility. Train is to meet the scheduled arrival and massive public transportations. The vehicle is the rubber tired tram and is all wheel steered single articulation. The vehicle can be automatically operated by navigation control system (NCS). For the automatic driving, the vehicle lanes will be marked with permanent magnets that are buried in the road. The control algorithm developed for navigation control has to be verified before being applied in the vehicle. In this purpose, we design the simulator for controller test of the bimodal tram.

• 한국철도학회:학술대회논문집
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• 한국철도학회 2010년도 춘계학술대회 논문집
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• pp.2283-2291
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• 2010

This paper evaluated the effectiveness for the case of it introduced the bimodal tram for the capital area adaptability of the bimodal tram in the limelight as the new transportation means of the next generation for capital area major transportation corridor. The KTDB with 1,142 zones was utilized for the analysis and the major transportation axis around the main road in which the traffic is high. The analysis index selected around the transportation index in which it can show up by the bimodal tram application and the decrease rate of the road traffic density, the travel time change, the carbon emission quantity change, and etc. was chosen as a result. It was analyzed as the axis in which the bimodal tram adaptability effect that it is high with the section this relative including the major analyzed result west AnSan IC~ Songsan Bridge, the SuWon terminal ~ SaDang station, the UiJungBu terminal ~ DoBongSan station, and etc. can be appeared and it was predicted that the travel demand reduction on the road of about 4~6% showed up.