• Archives of Reconstructive Microsurgery
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• 제14권2호
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• pp.105-111
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• 2005

Perforator flaps have become increasingly popular in microsurgery nowadays and are being used widely for many cases of reconstruction after trauma and cancer ablation. And thoracodorsal perforator based free flap is one of them having the merits of carrying a large skin paddle with leaving intact innervation and function of the remaining latissimus dorsi muscle. We made a homogeneous thin flap excluding the main muscle with a long vascular pedicle and tried to decrease the donor site morbidity. But, it needs a long learning-curve and we have met marginal flap necrosis frequently. Besides, prolonged operation time for complete perforator dissection may be a tedious job to the microsurgeon. To overcome these disadvantages, we usually included very small portion of the latissimus dorsi muscle during this flap elevation around the pedicled 2-3 thoracodorsal perforators during this flap elevation. We performed 3 cases of thoracodorsal perforator based free flap at Hallym university sacred heart hospital between May and August 2005 for the soft tissue defect of the scalp and feet. The average flap size was $8{\times}14\;cm$. Although it is not a true perforator flap, we can get the reliability for the flap survival with much better blood circulation and save the time of one or two hours to dissect the perforators completely. All cutaneous flaps survived completely without any complication except one fatty female who had the very small superficial fat necrosis due to flap bulkiness. We believe the thoracodorsal perforator based free flap can be extended its versatility and reliability by including the very small portion of the muscle around the perforators.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.11-18
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• 2002

Large soft tissue defects around the knee joint are known to significantly diminish joint function. Severe soft tissue defects on the anterior aspect of the knee joint especially bring on significant joint motion limitation. Although simple split skin grafts can cover the skin defect, the progressing scar contracture of the grafted skin causes joint stiffness. One of the best solutions of large soft tissue defects around the knee joint is covering the defect with a good quality skin flap. Separated flaps with one vascular pedicle are good candidates for covering anterior and posterior aspects of the joint for example. Authors performed 12 cases of combined scapular and latissimus dorsi free flaps from 1984 to 2000. Among them, we experienced 5 cases of knee joint defect covering using the double free flap for coverage of the soft tissue defect with preservation of the knee joint function and satisfactory results. The system of flaps based on the subscapular artery and vein provides a variety of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flap, the serratus anterior and latissimus dorsi muscular flap, the lateral scapular bone flap, the latissimus dorsi-rib flap, and the serratus anterior-rib flap. This combined flap is available for multiple tissue defects or complex defects because it can be incorporated with skin, muscle and bone flaps. A main advantage is the independent vascular pedicles of each component, which allow freedom in orientation of each components. Consequently it can be freely applied to any form of three dimensional defects on the upper and lower extremities. The combination of scapular cutaneous flap and latissimus dorsi musculocutaneous flap can be resurfaced for massive cutaneous defects on the extremities. We report the use of the combined scapular and latissimus dorsi free flap in five patients to reconstruct massive defects on the extremities with resultant improved joint function. There was no flap failure and minimal complications and disadvantages. The anatomy of this flap is reviewed and the indication and advantages are discussed. All of the five flaps survived and there was no scar contracture affecting the joint motion.

• 해부∙생물인류학
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• 제31권4호
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• pp.167-170
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• 2018

랑거겨드랑활은 겨드랑에서 흔히 나타나는 변이다. 랑거겨드랑활의 해부학적 그리고 임상적 중요성 때문에 이에 대한 관심이 많다. 학생실습과정에 68세 여성 시신의 오른쪽 팔에서 근육변이가 관찰되었다. 이 근육은 넓은등근의 가쪽모서리에서 근육의 형태로 일어났다. 그 후 힘줄의 형태로 겨드랑동맥과 정중신경을 가로질러 지나간 후 넓어지며 다시 근육의 형태로 큰가슴근에 부착되었다. 우리는 이 근육변이를 소개하고 이것의 임상적 의의에 대해 논의하였다.

• 한국임상수의학회지
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• 제29권5호
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• pp.368-371
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• 2012

본 연구는 개흉술을 실시한 11 마리 개에서 수술 후 흉강 내 음압 형성을 위한 흉강 튜브 삽입방법으로 넓은 등근 아래 흉강 튜브 삽입 방법의 효과를 평가하기 위해 실시 하였다. 흉강 튜브 삽입을 위해 수술 창 뒤쪽으로 다섯 번째 늑간 늑골 위 피부와 넓은 등근에 작은 절개창을 형성하였다. 지혈겸자를 장착한 흉강 튜브를 근육 아래 터널을 통과하여 흉강 내로 삽입하였으며 튜브 장착 후 절개창 주위에 매트리스 봉합법을 이용하여 봉합사를 설치하였다. 수술 후 흉강 내 음압을 형성한 다음 흉강 튜브를 제거하였다. 튜브 관련 부작용을 확인 하기 위해 튜브 삽입 시 튜브 꺽임 현상과 수술 후 신체 검사 및 방사선 검사를 통한 기흉, 피하 기종, 호흡곤란 여부를 확인 하였다. 튜브 삽입 시 튜브 꺽임 현상과 수술 후 기흉 및 호흡 곤란 증상이 11 마리 개 모두에서 확인 되지 않았다. 신체 검사에서 튜브 삽입 주위 피하 기종이 한 마리에서 관찰 되었으나 별다른 치료 없이 3일 후에 사라졌음을 확인 할 수 있었다. 음압 형성 후 평균 (${\pm}SD$) 추적 기간은 $19{\pm}10$ 개월 이었다. 결론적으로 넓은 등근 아래 흉강 튜브 삽입 방법은 튜브가 흉강 내 유지 될 때와 튜브 제거 후 남게 되는 터널을 통한 흉강 내 공기 유입 차단에 효과적이며 흉강 튜브 장착 시 우선적으로 고려 되야 할 방법으로 사료 된다.

• PNF and Movement
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• 제11권2호
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• pp.67-75
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• 2013

Purpose : This study according to the angle at the shoulder joint abduction compare muscle activity by analyzing abduction in normal depending on the angle of the shoulder joint which muscles are activated exactly know what its purpose is. Methods : 15 students with a healthy shoulder abduction angles ($45^{\circ}$, $90^{\circ}$) according to the trapezius (upper, midder, lower), infrasupinatus, deltoid, pectoralis major, serratus anterior, latissimus dorsi muscle activity of the were analyzed. How the% MVIC EMG activity of each muscle EMG signals were standardized. Results : The mean age of the study subjects 23.6 years old, and is a key 175.6Cm, weight 70.66Kg respectively. $45^{\circ}$ non-load Pectoralis major, load Deltoid, $90^{\circ}$ non-load Deltoid, Latissimus dorsi load showed the most activity. Conclusion : The purpose of this study the muscle activity of the muscles in order to mobilize the comparison of the active muscles, but the experimenter with a range of individual differences that every time I was able to find the average. Based on these results will be helpful in future studies.

• 정형스포츠물리치료학회지
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• 제14권2호
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• pp.99-107
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• 2018

Purpose: This study investigated scoliosis muscle activity after the trunk side shift exercise. Methods: Fifty-eight subjects (control group=30, scoliosis group=28) participated in this study. The patients with idiopathic scoliosis were randomly divided into two groups: the side shift exercise (SSE) group and the trunk stabilization exercise (TSE) group. The SSE group performed SSE with chair training for eight weeks. A one-way ANOVA test was carried out to compare the results within the idiopathic scoliosis patient group prior to and after different exercise methods. Result: The muscle activity differences of the TPS, LPS, and latissimus dorsi muscles significantly decreased in all idiopathic scoliosis exercises groups after training. According to the exercise method, the TPS differed between the control group (CG) and TSE group and between the SSC and TSE groups. The LPS and latissimus dorsi muscles showed differences between the CG and TSE groups. Conclusions: This study found that the side shift exercise effectively improve spine muscles. The side shift exercise was performed using chairs that were designed for this study. Thus, this method is easily accessible for busy students who are exposed to scoliosis or spinal disorders that are caused by a pattern of inactivity.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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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.

• 대한안전경영과학회지
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• 제11권3호
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• pp.79-85
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• 2009

In this study, the effects of psychosocial stress (box color and precision demand) on muscle activity were evaluated in laboratory setting. Eight subjects performed sagittally symmetric lifting tasks. Box color (yellow, black), precision demand (yes, no), and box weight (5%MVC, 10%MVC, 15 %MVC) were varied and surface EMG signals from seven muscles(medial deltoid right, biceps brachii right, lateral triceps right, latissimus dorsi right, erector spinae right, external oblique right, internal oblique right) were recorded. EMG signals were band-pass filtered($10{\sim}400\;Hz$), rectified, RMS smoothed and normalized (NEMG). Analysis of variance tests were conducted on the total NEMG (TNEMG: the sum of the seven muscles' NEMGs) and on the individual muscle's NEMGs. Box color had no effect on the TNEMG and on the seven muscles activities(p>0.05). When precision demand was required at the end point of lifts, the mean NEMG showed higher values than no precision demand conditions: TNEMG (14% increase) and medial deltoid(40% increase), biceps brachii(10% increase), lateral triceps(26% increase), latissimus dorsi(25% increase) muscles. Those increases showed more conspicuous as the box weight increased in the muscles of medial deltoid, lateral triceps, and latissimus dorsi.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.596-603
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• 2022

Background We suggested an easy and effective harvesting technique to avoid injury to tissues adjacent to the latissimus dorsi (LD). Methods Between 2007 and 2017, breast reconstruction was performed with an LD flap using the "bottom-up" technique. Medical records were retrospectively reviewed. Data on postoperative complications, results, and follow-up were obtained. Nine cadaveric dissections were performed to assess positional relationships between LD and adjacent muscles based on the ribs where relevant muscles and LD attach. Overall, 78 LD flaps were harvested without complications. Results Average age was 45.4 years. The mean operation time was 260minutes. There were no abnormalities or injuries in the adjacent fascia and muscles during the flap harvest. Drains were removed at an average of 21.9 days postoperatively. In all cadavers, there was conjoined fascia between the thoracolumbar and LD fasciae. The average level of the merging point between the LD and external oblique muscle (EOM) was 8.9 to 11.1 ribs. The average level of the overlapping point between the LD and serratus posterior inferior (SPI) was 9.5 to 11.1 ribs. Conclusions There are three dangerous zones during LD flap harvesting. The first zone is where the conjoined fascia encompasses the LD and thoracolumbar fasciae. The second zone is where the LD merges with the EOM and the serratus anterior. The third zone is the lower part where the LD merges with the SPI and EOM. The "bottom-up" technique enables a more meticulous and atraumatic operation by beginner flap surgeons.

• 대한물리의학회지
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• 제17권1호
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• pp.75-83
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• 2022

PURPOSE: This study was conducted to investigate the effect of the resistance respiratory muscle exercise with transcutaneous electrical nerve stimulation (TENS) on the respiratory muscle tone and pulmonary function of stroke patients. METHODS: Twenty stroke patients were divided into the TENS group (n = 7), placebo TENS group (n = 7), and control group (n = 6), and each intervention was performed on the three groups 5 times a week for 4 weeks. The assessment was carried out by measuring changes in the muscle tone of the latissimus dorsi and abdominal external obliques, and pulmonary function. RESULTS: In this study, the TENS group and the placebo TENS group had significant increases in the paretic side latissimus dorsi muscle tone, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). There was no significant difference in changes in respiratory muscle tone between the three groups. The pulmonary function was significantly different between the three groups, and it was observed from the results of the post-hoc test that FVC showed a significant increase in the TENS group and the placebo TENS group compared to the control group. CONCLUSION: Through this study, it was found that the respiratory muscle resistance exercise was more effective as a method to increase respiratory muscle tone and pulmonary function in stroke patients than combined transcutaneous electrical nerve stimulation.