• Archives of Plastic Surgery
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• v.33 no.4
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• pp.469-473
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• 2006

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. Methods: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. Results: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. Conclusion: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.

• Anatomy & Biological Anthropology
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• v.30 no.2
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• pp.61-65
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• 2017

This report describes a variation of the tendinous slip of the flexor digitorum longus (FDL) for the great toe. In addition, compositions of the long flexor tendons for all five toes were examined. The tendons of the FDL in the foot were investigated in 66 specimens of embalmed Korean adult cadavers. The tendons of the flexor hallucis longus (FHL) and the FDL with the lumbrical muscles were cut at the calcaneus and the metatarsophalangeal joints and were removed en bloc specifically to observe the FDL and the FHL tendons of the great toe. The tendinous slip of the FDL for the great toe was found bilaterally in the foot of a 52-year-old male. Its prevalence was two of 66 specimens (3.0%). The tendinous slip of the FDL for the great toe passed forward the great toe, and it constituted the superficial portion of the long flexor tendon for the great toe. The tendon of the FHL passed forward to constitute the deep portion of the long flexor tendon for the great toe. Thus, both the tendinous slip of the FDL and the tendon of the FHL composed the long flexor tendon for the great toe. The tendinous slip of the FDL and the tendon of the FHL for the great toe were similar in thickness; thus, each tendinous slip of the FDL and the tendon of the FHL were approximately one-half of the long flexor tendon for the great toe in thickness. The present study demonstrated an anatomical variation of the interconnection between the FHL and the FDL tendons, which will be useful for various surgeries and biomechanical research.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.35-45
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• 2011

Purpose: The purpose of this study was to document the structural features of the tendinous portions within the non-pathologic subscapularis muscle by performing high resolution MR imaging of the shoulder. Materials and Methods: Between April 2007 and May 2010, we retrospectively obtained the MR scans of 88 consecutive young patients (88 shoulders) who were in their twenties. MRI and MR arthrography were performed using a 3.0-T system for the evaluation of glenohumeral instability and nonspecific shoulder pain. None of the patient in this study had any evidence of injury to the tendon or muscle belly of the subscapularis. On MR images, we recorded the transverse length of a stout tendinous band and the total tendinous portion of the subscapularis. In addition, we recorded the number of intramuscular tendinous slips of the susbscapularis. Results: The mean transverse length of the tendinous band was 15.0 mm (range: 8 to 20 mm). The mean transverse length of the total tendinous portion was 48.9 mm (range: 40 to 60 mm). The number of intramuscular tendinous slips on the base of the glenoid fossa was 3 in 20 (22.72%), 4 in 45 (51.14%) and 5 in 23 shoulders (26.14%). On the lateral portion, the intramuscular tendinous slips became gradually rounder and thicker and they gave converge in the superior direction. Conclusion: In this study, the structural features of the tendinous portions of the subscapularis on the MR scans were identified. This will in return give good justification for the lines to be pulled during biomechanical stimulation and also for the surgical approach to restore the biomechanical function.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.663-668
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• 2008

Purpose: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. Methods: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. Results: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9 - 3.4cm and 1.8 - 3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7 - 7.0 cm on medial margin and 6.2 cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8 - 5.6 cm on medial margin and 2.7 - 6.2 cm on lateral margin. Conclusion: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8 cm on medial margin and 1.9 cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

• Journal of Korean Foot and Ankle Society
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• v.4 no.2
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• pp.87-92
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• 2000

The tendinous ends of neglected achilles tendon rupture tend to retract and separate with atrophy due to gastrosoleus muscle contracture, leaving a wide gap occupied with fibroadipose scar tissue. It is almost impossible to perform simple end-to-end anastomosis after the intervening scar tissue being excised. Therefore many surgical procedures have been proposed to reconstruct the large gap. We treated three such cases by V-Y advancement flap and double Krackow suture technique, and their postoperative strength of triceps surae were evaluated with Cybex isokinetic strength testing. All patients returned to preinjury activities with satisfaction, but the ankle plantar flexor power showed about 20-30% deficit.

• Journal of Chest Surgery
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• v.11 no.1
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• pp.97-101
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• 1978

Primary cyst of the diaphragm is a rather uncommon disease. This is a report of a case of diaphragmatic cyst, located in the tendinous portion of the right diaphragm. The patient had no specific symptoms in the respiratory systems, but suffered from gastrointestinal symptoms [indigestion, epigastralgia, and loss of appetite etc.] for 2 months. Accidentally, on a simple chest x-ray examination, a round homogenous mass density was discovered. Tomography showed a well circumscribed parenchymatous mass. So a coin lesion in the medial segment of the right lower lobe was suspected. A thoracotomy was performed. There were no pathological findings in the lung and pleura. A ping-pong ball sized round mass, which was soft, elastic and fluctuated,was noted in the tendinous portion of the diaphragm. It was enucleated completely without diaphragmatic rupture, and diagnosed as a primary diaphragmatic cyst [fibrous-walled] by the histopathologic examination. Postoperative course was uneventful.

• 대한정형외과스포츠의학회:학술대회논문집
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• 2006.09a
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• pp.17-31
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• 2006

대개 근위부 족저근막염에 의해 야기되는 족저부 뒤꿈치 통증은 흔한 족부 질환이다. 족저근막염을 가진 대부분의 환자에서 비수술적인 치료는 효과적이지만, 통증 해결은 1년까지 요구된다. 수술이 요구된다면, 근막의 절반 이상을 유리하는 것은 기능적인 결손을 피하기 위해 배제되어야 한다. 외측 족저신경의 감압은 무지외전근의 기시부 주위에 통증이 있는 환자에서 추가된고 족저 근막 유리술의 정해진 일부분이 된다. 가끔, 족저부 뒤꿈치 골극 절제술이 필요하지만 이것은 시술의 이환율을 더하고 회복 시간을 지연시킨다.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.6 no.2
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• pp.65-69
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• 2013

Rupture of biceps brchii is seen mainly in tendinous portion and intrasubstance rupture is rare. Author experienced 2 cases of intrasubstance rupture of biceps brachii diagnosed by sonographic examination which showed satisfactory result by conservative treatment.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.183-188
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• 2017

Background: To evaluate the clinical outcomes and associated repair integrity in patients treated with arthroscopic repair for a transtendinous rotator cuff tear followed by resection of the remnant rotator cuff tendon. Methods: Between July 2007 and July 2011, we retrospectively reviewed patients who were treated for transtendinous full-thickness tears in the tendinous portion of the rotator cuff by arthroscopic repair. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score, a visual analogue scale (VAS) pain score, and range of motion (ROM). The repair integrity was determined by magnetic resonance imaging or ultrasonography. Results: There were 19 shoulders with transtendinous full-thickness tears in the tendinous portion of the rotator cuff. The ASES, UCLA, Constant-Murley, and VAS pain scores showed significant improvements in function and symptoms (all p<0.001). The active ROM for forward flexion and abduction was also significantly improved (p=0.002 and p<0.001, respectively). The postoperative radiological examination showed cuff integrity without a re-tear in 68.4% of patients. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and re-torn group (p=0.530, p=0.885, and p=0.262, respectively). Conclusions: Although repair of transtendinous rotator cuff tears followed by resection of the remnant rotator cuff tendon in the footprint has a relatively high re-tear rate, no significant difference was observed in the short-term clinical results between the re-tear and healed groups.

• Journal of Biosystems Engineering
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• v.34 no.1
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• pp.57-62
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• 2009

Kinematic analysis of MTC (Muscle-Tendon Complex) units is a key indicator for diagnosis of patients with musculoskeletal disorders because the contracture or shortening of musculo-tendinous units is known to produce pathological gaits. Therefore, the principal objective of this study was to assess the length change in the triceps surae prior to and after wearing an AFO (Ankle-Foot Orthoses) in patients with musculoskeletal disorders during a gait. In this study, analyses were conducted using a Muscle Tendon Complex model coupled with the trajectory data from markers attached to anatomical landmarks. As a result, the maximum length change in the triceps surae during a gait was 4.87% when a barefoot walking group and a walking group with AFO were compared. In particular, the difference in length changes between both groups in Soleus MTC units was found to be statistically significant in all gait phases. Our results revealed that MTC length in the AFO walking group was clearly increased over that of the barefoot walking group. In the future, further studies will be required in order to more adequately assess musculoskeletal disorders using many cases studies with regard to agricultural working conditions because this study deals with the kinematic analysis of musculo-tendinous units in the case of clinical experiments.