• Archives of Plastic Surgery
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• v.49 no.1
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• pp.39-42
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• 2022

Bilateral pectoralis major myocutaneous (PMMC) flaps are commonly used to reconstruct large chest wall defects. We report a case of large chest wall defect reconstruction using bilateral PMMC flaps augmented with axillary V-Y advancement rotation flaps for additional flap advancement. A 74-year-old male patient was operated on for recurrent glottic squamous cell carcinoma. Excision of the tumor resulted in a 10×10 cm defect in the anterior chest wall. Bilateral PMMC flaps were raised to cover the chest wall defect. For further flap advancement, V-Y rotation advancement flaps from both axillae were added to allow complete closure. All flaps survived completely, and postoperative shoulder abduction was not limited (100° on the right side and 92° on the left). Age-related skin redundancy in the axillae enabled the use of V-Y rotation advancement flaps without limitation of shoulder motion. Bilateral PMMC advancement flaps and the additional use of V-Y rotation advancement flaps from both axillae may be a useful reconstructive option for very large chest wall defects in older patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.22 no.1
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• pp.51-58
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• 2016

Background: Evidence for effective management of scapular downward rotation syndrome is limited. The present study was performed to compare the scapular muscle activation through 4weeks wall slide exercise and sling slide exercise in subjects with scapular downward rotation syndrome. Methods: Twenty-two subjects with scapular downward rotation syndrome participated in the study. Surface electromyography data were collected from the upper and lower trapezius, serratus anterior and pectoralis major during shoulder flexion of $60^{\circ}$, $90^{\circ}$ and $120^{\circ}$ in the sagittal plane. The alignment of the scapula was measured using radiographic analysis. Subjects were assessed pre and post a 4 weeks exercise (wall slide, sling slide). The significance of the difference in pre- and post-exercise within each groups was assessed using a paired t-test. The significant difference between wall- and sling-exercise was used a independent t-test. Results: In the wall slide group, the muscle activity of upper trapezius decreased significantly during shoulder flexion at $60^{\circ}$, $90^{\circ}$ and $120^{\circ}$ after 4 weeks, and the muscle activity of serratus anterior increased significantly at all angles. Also, the muscle activity of pectoralis major decreased significantly at $90^{\circ}$ and $120^{\circ}$. Conclusions: Based on such results, it can be said that wall slide exercise is effective than sling slide exercise for the subjects with scapular downward rotation syndrome.

• Journal of Korean Physical Therapy Science
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• v.29 no.3
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• pp.48-55
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• 2022

Background: The purpose of this study is to examine the effect of push-up plus exercise on the changes in the thickness of the trapezius trapezius, serratus anterior and pectoralis major muscles involved in shoulder stability in various support surfaces. Design: Randomized controlled trial. Methods: The thickness change of the shoulder stabilizing muscle was measured using an ultrasound device. Corresponding t-test was performed to confirm the change within the group before the experiment and after 5 weeks. And one-way ANOVA was used to confirm the change between groups after 5 weeks. As a post hoc test, the least significant difference test was performed, and the significance level was set to a=0.05. Results: Changes in the thickness of the trapezius muscle within the group were significantly different between UPEG and SPEG after 5 weeks (p<0.05), and there was a significant difference between groups after 5 weeks (p<0.05). Changes in the thickness of the serratus anterior and pectoralis major muscle within the group were significantly different after 5 weeks in PEG, UPEG and SPEG (p<0.05), and the changes between the groups were significantly different in the serratus anterior muscle after 5 weeks (p<0.05). Conclusion: From the results of this study, it was found that the push-up exercise on an unstable support surface was effective for strengthening the trapezius upper and serratus anterior. This study intends to suggest the possibility of application as basic data for a push-up plus exercise program in clinical practice.

• Women's Health Nursing
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• v.29 no.1
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• pp.66-75
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• 2023

Purpose: Supportive interventions to improve breastfeeding practice are needed in nursing. This study investigated the effects of pectoralis major myofascial release massage (MRM) on breast pain and engorgement among breastfeeding mothers and on breast milk intake and sleep patterns among newborns. Methods: Breastfeeding mothers who had delivered between 37 and 43 weeks and had 7-to 14-day-old newborns were recruited from a postpartum care center in Gunpo, Korea. Participants were randomized to the MRM or control group. The outcome variables were breast pain and breast engorgement among breastfeeding mothers and breast milk intake and sleep time among newborns. The experimental treatment involved applying MRM to separate the pectoralis major muscle and the underlying breast tissue in the chest. After delivery, the first MRM session (MRM I) was provided by a breast specialist nurse, and the second (MRM II) was administered 48 hours after MRM I. Results: Following MRM, breast pain (MRM I: t=-5.38, p<.001; MRM II: t=-10.05, p<.001), breast engorgement (MRM I: right, t=-1.68, p =.100; left, t=-2.13, p=.037 and MRM II: right, t=-4.50, p<.001; left, t=-3.74, p<.001), and newborn breast milk intake (MRM I: t=3.10, p=.003; MRM II: t=3.09, p=.003) differed significantly between the groups. Conclusion: MRM effectively reduced breast engorgement and breast pain in breastfeeding mothers, reducing the need for formula supplementation, and increasing newborns' breast milk intake. Therefore, MRM can be utilized as an effective nursing intervention to alleviate discomfort during breastfeeding and to improve the rate of breastfeeding practice (clinical trial number: KCT0002436).

• Anatomy and Cell Biology
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• v.56 no.1
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• pp.145-149
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• 2023

Agenesis or congenital hypoplasia of skeletal muscles occurs infrequently but may occur with specific conditions such as Poland syndrome. The trapezius muscle can vary in the extent of its bony attachments or may have additional slips, however congenital absence or hypoplasia is extremely rare. There are only a few reports of partial or complete absence of the trapezius muscle. Two cases of bilateral absence of the trapezius were both in males and were accompanied by the absence of additional muscle in the pectoral girdle. Herein, we describe a case of a 56-year-old male cadaver with bilateral hypoplasia of the trapezius. The muscle was largely represented by atrophied muscle fibers with an abundance of fibrotic or fatty connective tissue. This subject had very minor hypoplasia of the left pectoralis major muscle, but the remaining muscles of the pectoral girdle were normal. The spinal accessory nerve terminated in the sternocleidomastoid muscle on both sides, failing to reach the trapezius. We interpret these findings to be consistent with a minor variant of Poland syndrome.

• Korean Journal of Acupuncture
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• v.23 no.2
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• pp.39-46
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• 2006

Objective & Methods: This study is performed to understand the interrelation between 'Foot yangmyung meridian-muscle' and 'muscular system'. We studied the literatures on Meridian-muscle theory, anatomical muscular system, myofascial pain syndrome and the theory of anatomy trains. Results & Conclusion: 1. It is considered that Foot yangmyung meridian-muscle includes extensor digitorum longus m., tibialis anterior m., quadriceps femoris m., rectus abdominis m., pectoralis major m., sternocleidomastoid m., platysma m., orbicular oris m., zygomaticus major m., zygomaticus minor m., masseter m., Gluteus medius m., and Obliquus externus abdominis m. 2. The symptoms of Foot yangmyung meridian-muscle are similar to the myofascial pain syndrome with referred pain of extensor digitorum longus m., tibialis anterior m., quadriceps femoris m., rectus abdominis m., obliquus abdominis m., masseter m. 3. Superficial frontal line in anatomy trains is similar to the pathway of Foot yangmyung meridian-muscle, and more studies are needed in anatomy and physiology to support the continuity of muscular system of Foot yangmyung meridian-muscle in aspect of anatomy trains.

• Korean Journal of Head & Neck Oncology
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• v.2 no.1
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• pp.49-59
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• 1986

The surgical reconstruction of major defects of the head and neck such as those following accidental injuries or resection of tumors has been facilitated and advanced by the development of myocutaneous flaps which provide both muscle bulk and skin coverage. Of the many available myocutaneous flaps, the pectoralis major myocutaneous flap has many advantages such as abundant tissue with an excellent vascularity, anatomic proximity, long arc of rotation, reliability and versatility, so it is used most frequently in head and neck reconstruction. It is the purpose of this paper to present our experiences with two cases of pectoralis major myocutaneous island flaps used in reconstruction of major defects of face; one is after resection of very large basal cell carcinoma of the left oral commissure and the other is after resection of a huge fibrous mass and destructed facial bones caused by chronic osteomyelitis.

• Physical Therapy Korea
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• v.26 no.3
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• pp.1-10
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• 2019

Background: Winged scapular (WS) causes muscle imbalance with abnormal patterns when moving the arm. In particular, the over-activation of the upper trapezius (UT) and decrease in activity of the lower trapezius (LT) and serratus anterior (SA) produce abnormal scapulohumeral rhythm. Therefore, the SA requires special attention in all shoulder rehabilitation programs. In fact, many previous studies have been devoted to the SA muscle strength training needed for WS correction. Objects: The purpose of this study was to investigate the effect of shoulder girdle muscle and ratio according to the angle of shoulder abduction and external weight in supine position. Methods: Twenty three WS patients participated in this experiment. They performed scapular protraction exercise in supine position with the weights of 0 kg, 1 kg, 1.5 kg, and 2 kg at shoulder abduction angles of $0^{\circ}$, $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$. The angle and weight applications were randomized. Surface electromyography (EMG) was used to collect the EMG data of the SA, pectoralis major (PM), and UT during the exercise. The ratio of PM/SA and UT/SA was confirmed. Two-way repeated analyses of variance were used to determine the statistical significance of SA, PM, and UT and the ratios of PM/SA and UT/SA. Results: There was a significant difference in SA according to angle (p<.05). Significant differences were also identified depending on the angle and weight (p<.05). The angle of abduction at $0^{\circ}$, $30^{\circ}$ and weight of 2 kg showed the highest SA activity. However, there was no significant difference between PM and UT (p>.05). There was a significant difference between PM/SA and UT/SA in ratio of muscle activity according to angle (p<.05). Significant differences were found at PM/SA angles of $30^{\circ}$, $60^{\circ}$ and $90^{\circ}$ (p<.05). For UT/SA, significant difference was only observed at $90^{\circ}$ (p<.05). Conclusion: Based on the results of this study, in order to strengthen the SA, it was found to be most effective to use 1 and 1.5 kg weights with abduction angles of $0^{\circ}$ and $30^{\circ}$ at shoulder protraction in supine position.

• Journal of the Korean Applied Science and Technology
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• v.35 no.1
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• pp.36-42
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• 2018

This study was to investigate the difference of muscle activities in trunk, upper arm, and shoulder during push-up exercise based on 3 types of different arm position(posterior position, PP; normal position, NP; and anterior position, AP) and to provide effective push-up arm position for each muscle development. Fifteen healthy males(age, $21.5{\pm}0.5years$; height, $172.7{\pm}1.0cm$; body mass, $70.5{\pm}1.3kg$; shoulder width, $42.3{\pm}0.6cm$; and BMI, $23.6{\pm}0.5kg/m^2$) participated in this study. PP, NP, and AP of the arm were used to conduct push-up exercise and 8 muscles(deltoideus p. acromialis: DA; pectoralis minor: PMI; pectoralis major: PMA; serratus anterior: SA; biceps brachii: BB; triceps brachii: TB; latissimus dorsi: LD; and infraspinatus: IS) of right side were selected to measure muscle activities. Total 9 counts of push-up exercise were conducted and EMG data signals of 5-time(from $3^{th}$ to $7^{th}$) push-up movement were used for measuring muscle activities. PP push-up exercise showed that there was a significantly higher muscle activity of DA, PMI, PMA, SA, BB, LD, and IS(p<.05) and AP push-up exercise showed a significantly higher TB activity(p<.05). It would be suggested that different arm position evokes various muscle activities when conducting push-up exercise. PP would be the best push-up arm position for inducing various trunk, upper arm, and shoulder muscle activities compared to NP and AP.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.228-234
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• 2011

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma, deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.