• Archives of Reconstructive Microsurgery
• /
• v.9 no.2
• /
• pp.114-119
• /
• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• Korean Journal of Applied Biomechanics
• /
• v.24 no.2
• /
• pp.139-149
• /
• 2014

The purpose of this study was to evaluate the effect of angle change of forefoot's adhesive outsole on the electromyographic activity (EMG) of the erector spinae and selected lower limbs muscle during downhill walking over $-20^{\circ}$ ramp. Thirteen male university students (age: $25.4{\pm}3.9$ yrs, height: $176.2{\pm}5.1$ cm, weight: $717.4{\pm}105.0$ N) who have no musculoskeletal disorder were recruited as the subjects. To assess the myoelectric activities of selected muscles, six of surface EMG electrodes with on-site pre-amplification circuitry were attached to erector spinae (ES), rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), lateral gastrocnemius (LG), and medial gastrocnemius (MG). To obtain maximum EMG levels of the selected muscles for normalization, five maximum effort isometric contraction were performed before the experimental trials. Each subject walked over $0^{\circ}$ and $20^{\circ}$ ramp with three different forefeet's EVA outsole (0, 10, $20^{\circ}$) in random order at a speed of $1.2{\pm}0.1$ m/s. For each trial being analyzed, five critical instants and four phases were identified from the recording. The results of this study showed that the average muscle activities of MG and LG decreased in $20^{\circ}$ shoes compared to $0^{\circ}$ and $10^{\circ}$ ones in the initial double limb stance (IDLS). In initial single limb stance (ISLS) phase, the average muscle activities of ES increased with the angle of forefoot's adhesive outsole, indicating that the increment of shoes' angle induce upper body to flex anteriorly in order to maintain balance of trunk. In terminal double limb stance (TDLS) phase, average muscle activities of TA significantly increased in $20^{\circ}$ outsole compared to $0^{\circ}$ and $10^{\circ}$ ones. There was no external forces acting on the right foot other than the gravity during terminal single limb stance (TSLS) phase, all muscles maintained moderate levels of activity.

• Korean Journal of Acupuncture
• /
• v.22 no.1
• /
• pp.7-21
• /
• 2005

Objectives : In the present study, the effect of electroacupuncture (EA) applied to SI6 and won-rak point on the ankle sprain model was examined. A common source of persistent pain in humans is the lateral ankle sprain. Methods : To model this condition, the rat's right ankle was bent repeatedly, overextending lateral ligaments, for 4 min under enflurane anesthesia. The rat subsequently showed swelling of the ankle and a reduced stepping force of the affected limb for the next several days. The reduced stepping force of the limb was presumably due to a painful ankle. EA was applied to the several acupuncture point on the contralateral forelimb for 30 min under gaseous anesthesia. After the termination of EA, behavioral tests measuring stepping force and Paw volume were Periodically conducted during the next 4 h and 18 h respectively. Results : EA applied to $SI_6$ with won-rak point produced more powerful improvement of stepping force of the sprained foot than to $SI_6$ alone lasting for at least 4 h. However, neigher $KI_4$ point nor $BL_{64}$ point produced any significant increase of weight bearing force. The improvement of stepping pressure was interpreted as an analgesic effect. The analgesic effect was specific to the acupuncture point since the analgesic effort on the ankle sprain pain model could not be mimicked by EA applied to $KI_4$ or $BL_{64}$. In addition, EA applied to $SI_6$ with won-rak combination point showed inhibitory effect on the paw edema induced by ankle sprain. Also, COX-2 protein expression increased by ankle sprain were suppressed by the EA stimulation. Conclusion : These data suggest that EA with won-rak combination point produces a more potent analgesic effect on the ankle sprain pain model in the rat and that EA with won-rak combination point induced anti-inflammatory effect through the suppression of COX-2 protein expression.

• Journal of Korean Dental Hygiene Science
• /
• v.1 no.2
• /
• pp.41-52
• /
• 2018

The purpose of this study was to examine the state of oral prophylaxis practice among dental hygiene students and their awareness of musculoskeletal diseases in an effort to provide some information on how to strengthen education on treatment posture to manage musculoskeletal diseases and how to raise awareness of musculoskeletal diseases. From November 2 to 13, 2016, a self-administered survey was conducted on 653 sophomores, juniors and seniors with an experience of oral prophylaxis practice. SPSS version 20.0 for Windows was employed to analyze the collected data. The findings of the study were as follows: 1. The largest group that accounted for 37.4% responded that the total number of students undergoing oral prophylaxis practice during a semester was four to six. The biggest group that represented 65.4% answered that the required practice time per student was one to fewer than three hours. 76.0% continued to be in the repeated same posture. 2. As for the posture of patients, supine position was most common for the maxillary sinus, which accounted for 82.2%. And semi-upright position was most common for the mandibular sinus, which represented 49.6%. 3. In regard to the burden of oral prophylaxis practice, 33.9% considered the required for the practice appropriate. 42.3% took the repeated long-lasting posture, and 53.5% were under physical pressure. 55.4% suffered from mental pressure and stress. 4. The most dominant musculoskeletal area that they experienced pain after oral prophylaxis practice was neck with 52.5%; waist with 48.2, shoulders/wrists/hands with 45.5, back with 10.3, buttocks with 4.1, elbows with 2.3, legs with 2.1, ankles/feet with 0.8 and knees with 0.6%. 5. Concerning the maintenance of repeated treatment postures and pain experience, the students who continued to be in the repeated same position underwent more pain than the others who didn't on the shoulders(2.92±1.05), in the waist(3.02±1.01), buttocks(1.75±0.92), elbows(1.55±0.79) and ankles/foot(2.52±1.25). The differences were statistically significant(p<.05, p<.01). 6. As to educational experience on treatment posture and musculoskeletal diseases, 88.8% received education on treatment posture; 87.9%, on what position should be taken in times of cooperation; 46.9%, on musculoskeletal diseases; 51.9%, on carpal tunnel syndrome; 42.3%, on varicose vein. The students who replied education on occupational diseases was necessary accounted for 89.6%. 7. The students who experienced treatment posture education were better aware of the causes of musculoskeletal diseases(3.23±3.00), ways for preventing the diseases(3.33±.834) and how to stretch the body(3.63±.858). The differences were statistically significant(p<.05, p<.001). 8. The students who experienced education on occupational diseases heard more about musculoskeletal diseases(3.27±.965), were better cognizant of the causes of the diseases(3.45±.847), were better aware of how to prevent them(3.55±.805) and found themselves to know how to stretch to prevent the diseases (3.73±.826). The differences were statistically significant(p<.001).

• Journal of muscle and joint health
• /
• v.8 no.1
• /
• pp.86-108
• /
• 2001

This study was performed to examine the annual experience rate of musculoskeletal symptom and its related factors in rural farmers. Six-hundred and sixty one rural farmers were investigated by questionnaire survey through interview from July 1 to July 31 in 2000. The results were as follows; The rural farmers who had experienced musculoskeletal symptom during recent 1 year was 82.7% in male, 92.1% in female. The annual experience rate of musculoskeletal symptom by part of the body in male were turned out as back; 42.3% leg and knee; 36.4%, shoulder; 21.4%, arm and hand; 12.7%, elbow; 7.7%, hip; 6.8% neck; 6.4%, ankle and foot; 6.4% in order. The annual experience rate of musculoskeletal symptom by part of the body in female were turned out as back; 59.4%, leg and knee; 48.5%, shoulder; 20.2%, arm and hand; 13.8%, hip; 10.7%, neck; 6.8%, ankle and foot; 6.3%, elbow; 5.0% in order. The annual experience rate of musculoskeletal symptom, back pain, and pain on leg and knee were significantly higher in female. In male, the experience rate of musculoskeletal symptom was different significantly according to educational level, family size, economic status, status of smoking, duration of farming, type of major agricultural affairs. By the multiple logistic regression analysis for experience of musculoskeletal symptom, family size and economic status were the significant variables. It was higher in male with no or one family living together and low economic status. In female, the experience rate of musculoskeletal symptom was different significantly according to body mass index, perceived health status, type of agricultural affairs. By the multiple logistic regression analysis for experience of musculoskeletal symptom, body mass index, perceived health status, and type of major agricultural affairs were the significant variables. It was higher as female farmer's body mass index was increasing and when female farmer's perceived health status was not healthier, and it was lower when female farmer did livestock farming as major agricultural affair. The experience rate of musculoskeletal symptom was higher in the busy season for farmers and treatment methods for musculoskeletal symptom were physical therapy, medication, herb medical treatment, etc. In conclusion, because most of farmers experience musculoskeletal symptom, continuous systematic study on musculoskeletal symptom of farmers and active effort to prevent and manage musculoskeletal symptom of farmers are necessary.

• Child Health Nursing Research
• /
• v.4 no.2
• /
• pp.159-176
• /
• 1998

In effort to conduct comparative study on the caregiving environment of Neonatal Intensive Care Unit(NICU) in both U. S and Korea, this study was been conducted first in the U.S. Purpose : The purpose of this study is to identify the physical environment and direct caregiving practices to lowbirth weight infants in NICU in the US. It also aims to examine the NICU outcome status and behavioral reponses of lowbirth weight infants. Methods : A study design using descriptive and inferential statistics was been conducted through an observational, field method. A sample of 15 preform infants admitted to NICU were recruited for the study. The subjects were those with birth weight between 1,000 gm to 1,500 gm, born at the gestation period of 27 to 33 weeks, and without any chromosomal or other genetic anomalies, major congenital infections, or maternal illness. Thirty minutes observation(three times of ten minutes of continuous observation)of the infant's behavior and physiological status, and an four-hour observation of the physical environment and direct care giving procedures were been conducted on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. The data to be collected were in four areas : the demograghic characteristics of the infants, the physical environment and care giving procedures, the frequency of the infant's designated behavior and physiological response, and NICU outcome variables. A descriptive analysis and Kruskal-Wallis, Pearson r were been applied according to variable characteristics. Results : 1. Mother's mean age was 29.47. The sample consisted of 6 males and 9 females. Mean gestational ages were 29.17 weeks. Mean birth weight was 1236.33g. Mean Apgar scores at one minute were 6.6, and 7.8 at five minutes. 2. The location for the incubator was in the distance from the light, X-ray screens and nursing station, in proximity to side-lamp, telephone and faucet on the third day after birth. The location for the incubator was in the distance from the light and radio on the tenth day and in proximity to nursing station on the day of dischage from the NICU or at 34weeks postconception. 3. Nesting was the most applying aids to the infants. And foot roll, shielding and plastic frame were frequently using by nurses for facilitating well modulated restful posture. 4. There were statistically significant changes in the patterns of physical environment included locating the infant's incubator and bedding, specific aids to self regulation on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 5. Statistically significant changes were not appeared in the patterns of direct caregiving procedure to the infants included stress inducing or reducing manipulations on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 6. The stress response of the infants in NICU were significantly reduced as the infants grow older. 7. There were not statistically significant correlation between the physical envronment and the stress responses of the infants in NICU. 8. There were statistically significant correlation between the direct caregiving procedure to the infants and the stress response of the infants in NICU in the second and third observation on the day three. 9. Average weight gain per day from birth to discharge was 38.73g, number of days in the hospital was 42.60, number of days before bottle feeding was 3.6. Postconception age starting bottle feed ing was 31/sup +5/ weeks. Number of days on mechanical ventilator was average 7.64, 11.42 was an average number of days of oxygen need. Conclusion : It, thus, appears that to minimize the sensorymotor stimulation for the low birthweight preterm infant in NICU, manipulation of care giving practices to the babies whatever the stress inducing or reducing procedures, have to be limited in the immediate early stage after birth. And it needed to be reexamine to identify the appropriate and specific physical environment and the patterns of direct caregiving to the low birthweight preform infant as the infants grow older in NICU.