• Archives of Plastic Surgery
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• v.36 no.1
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• pp.75-79
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• 2009

Purpose: The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. Method: Case1: A 50 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done. Results: Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients. Conclusion: LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstructio.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.14-17
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• 2013

Purpose: The open abdomen is now the standard of care in various clinical situations, especially it is used to treat abdominal compartment syndrome. Many techniques have been reported for closure after an open abdomen, but most take a long time for complete definitive closure and are associated with various problems. We describe a technique using biologic mesh that can achieve early definitive closure after an open abdomen. Methods: A 45-year-old man presented to the emergency room with a painful hip and painful lower extremities after a fall from 80 feet. Radiologic examination revealed multiple fractures of the pelvis and low extremities. Abdominal compartment syndrome caused by a retroperitoneal hematoma developed during the orthopedic surgery. We performed exploration immediately and closed abdomen temporarily. A peritoneal graft of porcine dermal collagen with anterior myofascial approximation of the rectus abdominis muscles and sliding skin flap was performed three days after the previous surgery. Results: There were no complications related to the wound. The patient was transferred to the Department of Orthopedic Surgery seven days after the initial surgery. Conclusion: Early definitive closure using porcine dermal collagen is a feasible method that can reduce the length of hospitalization and the number of operations for an open abdomen.

• Childhood Kidney Diseases
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• v.22 no.2
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• pp.86-90
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• 2018

Non-infectious complications of peritoneal dialysis (PD) are relatively less common than infectious complications but are a potentially serious problem in patients on chronic PD. Here, we present a case of a non-infectious complication of PD in a 13-year- old boy on chronic PD who presented with symptoms such as hypertension, edema, dyspnea, and decreased ultrafiltration. Chest and abdominal radiography showed pleural effusion and migration of the PD catheter tip. Laparoscopic PD catheter reposition was performed because PD catheter malfunction was suspected. However, pleural effusion relapsed whenever the dialysate volume increased. To identify peritoneal leakage, computed tomography (CT) peritoneography was performed, and a defect of the peritoneum in the left lower abdomen with contrast leakage to the left rectus and abdominis muscles was observed. He was treated conservatively by transiently decreasing the volume of night intermittent PD and gradually increasing the volume. At the 2-year follow-up visit, the patient had not experienced similar symptoms. Patients on PD who present with refractory or recurrent pleural effusion that does not respond to therapy should be assessed for the presence of infection, catheter malfunction, and pleuroperitoneal communication. Thoracentesis and CT peritoneography are useful for evaluating pleural effusion, and timely examination is important for identifying the defect or fistula.

• Food Science of Animal Resources
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• v.37 no.4
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• pp.593-598
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• 2017

The objective of this study was to determine the influence of quality grade (QG) on meat tenderness characteristics of ten major muscles from Hanwoo steers. A total of 25 Hanwoo carcasses ($5\;carcasses{\times}5\;QGs$) were selected. Intramuscular fat content, collagen content, sarcomere length, and Warner-Bratzler shear force (WBSF) of Longissimus thoracis (LT), Longissimus lumborum (LL), Psoas major (PM), Semisponals (SS), Triceps brachii (TB), Semimembranosus (SM), Gluteus medius (GM), Rectus Abdominis (RA), Superficialis flexor (SF), and Internal and external intercostal (IC) were determined. IC had the highest fat content, followed by LT, RA, LL, PM, GM, SS, SF, TB, and SM. High-fat muscles such as LT, LL, IC, RA, and PM had significantly (p<0.05) different fat contents among QGs. Collagen contents were significantly (p<0.05) different among QGs. With decreasing QG, increasing collagen content was found in muscles. There were significant (p<0.05) differences in sarcomere length among QGs of several muscles. However, no significant (p>0.05) difference in sarcomere length was found among QGs for LL, PM, or RA muscle. PM had the lowest WBSF, followed by LL, LT, RA, IC, GM, SM, SF, SS, and TB. WBSF of QG $1^{{+}{+}}$ was lower than that of QG 1 for SS, TB, and SM. All muscles of QG 1 showed lower WBSF than QG 3 except TB or IC. Results of this study suggested that differences in WBSF among these 10 muscles by QG were due to differences in collagen content and sarcomere length.

• Physical Therapy Rehabilitation Science
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• v.9 no.3
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• pp.201-208
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• 2020

Objective: This study aimed to identify the effects of performing shoulder and hip abduction during the V-sit exercise on abdominal muscle activity. Design: Cross-sectional study. Methods: Thirty healthy adults volunteered for this experiment. The participants randomly performed 6 types of V-sit exercises, including V-sit alone (hip 0°, shoulder 0°), V-sit with hip abduction 0° and shoulder abduction 15°, V-sit with hip abduction 0° and shoulder abduction 30°, V-sit with hip abduction 15° and shoulder abduction 0°, V-sit with shoulder and hip abduction 15°, and V-sit with shoulder abduction 30° and hip abduction 15°. EMG data were recorded from the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles of both sides. All abdominal EMG data during the six types of V-sit exercises were measured for 5 seconds, three times, and recorded for the middle 3 seconds excluding the 1 second at the start and end. Results: V-sit with shoulder abduction 30° resulted in significantly greater muscle activity of both RA, EO compared to shoulder abduction 0°, shoulder abduction 15° (p<0.05) and V-sit with shoulder abduction 15° showed significantly greater muscle activation of the RA compared with shoulder abduction 0° (p<0.05). The muscle activity of both EO and IO in the V-sit with hip abduction 15° was significantly greater than hip abduction 0° in all shoulder conditions (p<0.05). Conclusions: Greater angles of shoulder and hip abduction produced more abdominal muscle activity increases during the V-sit exercises. Shoulder abduction affected the RA, EO muscle activation and hip abduction affected the EO, IO muscle activation. This study showed that shoulder and hip abduction during V-sit exercises enabled effective activation of the trunk muscles.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.384-389
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• 2012

Background Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction. Methods Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period. Results Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap. Conclusions The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.140-146
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• 2009

Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

• The Journal of Korean Physical Therapy
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• v.25 no.1
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• pp.16-22
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• 2013

Purpose: This study evaluated the validity of measuring paravertebral muscle function with 3D-NEWTON (Hanmed, Korea) by assessing the correlation between Biodex (Biodex, USA) and surface electromyography (EMG). Methods: Nineteen healthy adults participated. The function of their paravertebral muscle was measured in three ways. Maximum endurance time was measured in seconds when 3D-NEWTON was inclined forward for assessing extensor function, and inclined backward for assessing flexor function. Using surface EMG, maximum muscle activity was obtained from the eractor spinae and rectus abdominis during the 3D-NEWTON measurement. Maximum muscle activity was the mean activity from 10 seconds when the root mean squared firing data was highest. Through Biodex the peak torques of the extensor and flexor were measured during isometric exercises. The Spearman correlation coefficiencts from 3D-NEWTON, surface EMG, and Biodex were calculated. Results: The data from surface EMG and Biodex were statistically correlated when measured for flexor function, but less so for extensor function. In the case of 3D-NEWTON, the correlation coefficient with Biodex was 0.50 (p=0.05), while the coefficient with surface EMG was 0.53 (p=0.02) when measured for extensor function. Similarly, the correlation coefficienct with Biodex was 0.60 (p=0.01), while the surface EMG was 0.51 (p=0.03) for flexor function. Conclusion: 3D-NEWTON was a useful method for measuring paravertebral muscle function and can give helpful information for treating people with diseases associated with the lumbar spine.

• The Journal of Korean Physical Therapy
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• v.32 no.4
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• pp.210-216
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• 2020

Purpose: This study examined the effects of curl-up using XCO^® on trunk muscle activation in healthy adults. Methods: This study design was a single-blind randomized controlled trial. Twelve participants were enrolled in this study. The subjects were instructed to perform curl-up exercise in STCU (straight curl-up), LTCU (left twist curl-up), RTCU (right twist curl-up), TWCU (twist curl-up), and PPCU (power push curl-up). Electromyography was used to assess the percent maximal voluntary isometric contraction (%MVIC) of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES) muscles. The data were analyzed using two-way ANOVA with a repeated measure. The statistical significance level was set to α=0.05 Results: The IO showed significant differences in the main effect of the group and the interactions between the group and exercise (p<0.05). In particular, the IO represented the interactions between group and exercise in the RTCU and PPCU (p<0.05). The RA, EO, and ES did not show significant interactions between the group and exercise (p>0.05). The RA, IO, and EO showed significant differences in the main effect of the group (p<0.05). The EO showed a significant difference in the main effect of exercise (p<0.05). Conclusion: These findings suggest that XCO^® can be used to increase the muscle activation of the internal oblique, which is the lumbar stabilizing muscle, when XCO^® is combined in the curl-up exercise with rotation. In the future, research on the intensity, frequency, and duration of XCO^® exercise will be needed according to the individual characteristics and preferences.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.49-54
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• 2009

Purpose: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. Materials and Methods: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. Results: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. Conclusion: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.