• Archives of Plastic Surgery
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• v.34 no.4
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• pp.448-454
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• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.715-717
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• 2011

Purpose: In cases of breast reconstruction with a free transverse rectus abdominis musculocutaneous (TRAM) flap after skin-sparing mastectomy with nipple-areolar complex (NAC) removal, the flat contour of the flap's skin paddle can easily look unnatural and dissatisfying. Reconstructed NAC on the flap surface lacks the elevated contour that the normal areola possesses, resulting in an unnatural final result. Therefore, we would like to introduce a novel method to improve this problem and report the satisfactory results we obtained. Methods: Operations were conducted on 19 patients who underwent immediate breast reconstruction with a free TRAM flap and skin-sparing mastectomy from January 2009 to January 2010, with a mean follow-up of nine months. While the TRAM free flap was being inset, a purse-string suture was carried out on the dermal layer of skin flap to create a slight protrusion with Gore-$Tex^{(R)}$ sutures. Results: The elevated mound surrounding the NAC was well maintained for an average follow-up period of nine months. Nipple projection was also well maintained. There was no complaint about breast contour or nipple height reduction. In addition, there was no reported incidence of other complications. Conclusion: The purse-string suture technique presents a more natural breast silhouette around the NAC and helps to maintain nipple projection. Furthermore, it does not require any supplementary incisions or complicated skills. There has been no report of additional complications using this technique.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.401-407
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• 2011

Purpose: A number of flap for nipple reconstruction have been well described in the literature. However, most of these techniques do not permit the reconstruction of a projecting nipple and all are hampered to some extent by long-term loss of nipple projection. The objective of this study is to evaluate the long-term result and clinical efficacy of nipple reconstruction using skate flap technique after breast reconstruction. Methods: A retrospective chart review was carried out on 23 patients who underwent 25 nipple reconstructions. In those patients with greater than 10 mm nipple projection, reconstruction with skate flap and full-thickness skin graft and/or tattooing was performed. Maintenance of nipple projection was then carefully assessed over one-year follow-up. The following factors were analyzed: type of breast reconstruction, type of areola reconstruction, followup period, decrease in nipple projection, complication, and whether secondary nipple reconstruction was necessary and/or performed. Results: Breast reconstructions were performed in 17 patients with free transverse rectus abdominis musculocutaneous flap, 3 patients with extended latissimus dorsi musculocutaneous flap, and 3 patients with expander and implant. The mean follow-up after nipple reconstruction was 17 months. Mean loss of projection were $17.0{\pm}13.99%$, $25.0{\pm}12.70%$, $30.0{\pm}12.57%$ and $30.8{\pm}12.49%$ at 3, 6, 9 months and over one year, respectively. The greatest decrease in projection was noted in the first 3 months following surgery. Conclusion: These results indicated that nipple reconstruction with skate flap showed about 70 percent of the projection achieved over one year postoperation. Therefore, the skate flap may be a reliable method of nipple reconstruction in those patients with greater than 10 mm nipple projection.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.555-558
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• 2009

Purpose: The high success rate of free flap transfers is well documented in previous literature, and is possible due to the early detection of vascular compromise and timely reoperation. We specifically analyzed the operative results of immediate and delayed reconstruction with free transverse rectus abdominis musculocutaneous(TRAM) flap respectively in order to reveal its distinctive features on timing and causes of vascular compromise. Methods: The senior author operated on 158 patients, 161 cases of free TRAM flap for breast reconstruction. 51 patients underwent delayed reconstruction, whilst immediate reconstruction was performed in the other 107 patients. All patients were monitored every 3 hours for the first 3 days. We reviewed medical records of all patients, and tested statistical significance with the Fisher's test. Results: Reoperation was performed in 20 cases, but the cases include hematoma with bleeding focus and arterial anastomosis site rupture due to abrupt arm abduction. We performed reoperation in 15 cases of suspicious vascular compromise. Flap compromise was noticed mostly within 24 hours, but not longer than 72 hours. Venous compromise was dominant by 11 cases (73.3%). There was difference in the timing of flap compromise between immediate and delayed reconstruction. All the cases of delayed reconstruction did not show signs of vascular compromise after 12 hours postoperatively. On the other hand, cases of vascular compromise were observed until 72 hours postoperatively in cases of immediate reconstruction. Conclusion: Delayed reconstruction showed vascular compromise within 12 hours postoperatively, while immediate reconstruction showed compromised until the 3rd postoperative day. If more aggressive monitoring is maintained during this period, we believe salvage of flaps may be increased with more efficiency.

• Journal of International Academy of Physical Therapy Research
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• v.4 no.1
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• pp.523-531
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• 2013

Most patients with chronic low back pain experience functional disability of trunk muscle, and limitations in physical activity. While there are many types of exercise programs available, in recent years sling exercise has been emerging as the exercise program for spinal stabilization. It has been supported by a great amount of research with positive findings on its effectiveness. This research studies the effects of bridging exercise, conducted on a sling, on pain level and trunk muscle activation in supine, sidelying, and prone positions during a 4 weeks period. 10 healthy people(normal group, n=10) and 28 patients with low back pain participated in this study. 28 patients were divided into two groups; one group participated in exercise with the sling(experimental group, n=14) and the other group exercised without the sling(control group, n=14). They were asked to use the Numerical Rating Scale(NRS) to answer to the level of their pain they felt (no pain: 0 point, severe pain: 10 points). During sling bridging exercises, the muscle activity level in each muscle measured in each position was standardized as three seconds of EMG signals during five seconds MVIC. In conclusion, the experimental group with four weeks of sling bridging exercise experienced a statistically significant reduction in the pain level(p<.05) and increase in the muscle activities of erector spinae when in supine position, internal oblique when in sidelying position, and rectus abdominis in prone position(p<.05). Regular sling bridging exercise reduces the low back pain and enhances other trunk muscle activation, thereby positively affect spinal stabilization.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.4
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• pp.113-121
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• 2018

PURPOSE: This study was conducted to identify a more effective intervention in sling and resistance exercise for chronic low back pain patients. METHODS: Seventy (70) subjects were randomly divided into the sling group (SG) and resistance exercise group (REG). Muscular activity of the internal oblique (IO), external oblique (EO), rectus abdominis (RA), and pelvic rotation angle during active straight leg raise (ASLR), a pressure pain threshold (PPT) and a visual analog scale (VAS) were measured. Sling and resistance exercises were conducted for 12 weeks. Intermediate measurements were taken after 8 weeks and final measurements were taken after 12 weeks. RESULTS: Both groups showed significantly decreased RA muscle activity and significantly increased IO muscle activity (p<.05). Additionally, EO muscle activity was significantly decreased in the REG, but significantly increased in the SG (p<.05), while the pelvic rotation angle and VAS were significantly decreased in the SG (p<.05). The pressure pain threshold was significantly increased in both groups (p<.05). CONCLUSION: Based on the results of this study, a 12-week intervention seems to be effective at improving back pain in both groups. However, a lower VAS was seen in the sling group after 8 weeks of intervention. Therefore, it is recommended that the sling be applied first when establishing a chronic back pain treatment program to shorten the treatment period and reduce the pain period.

• The Journal of Korean Medicine
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• v.40 no.1
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• pp.99-113
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• 2019

Objectives: This study is designed to identify the responses of autonomic nervous system and gastrointestinal function which are induced by acupuncture at abdominal anterior cutaneous nerve. Methods: This study is one group before and after pilot study. Subjects were treated once, after having been fasting six hours. They had before tests, labeling points for acupuncture, acupuncture, and after tests in order. The points of acupuncture were motor points of rectus abdominis where the abdominal anterior cutaneous nerve came to the skin from abdominal wall. Before and after tests were consisted of three things: Digital Infrared Thermographic Imaging(D.I.T.I.), Heart Rate Variability(HRV), and Recording of bowel sounds. Results: There were significant differences on the skin temperature of upper body and the frequency of bowel sounds(p<0.001, p<0.001). The HRV parameters and volume of bowel sounds had no significant differences(p>0.05, p>0.05). Conclusion: Even though no significant differences in HRV parameters, the significant differences of skin temperature of upper body and frequency of bowel sounds could mean acupuncture at abdominal anterior cutaneous nerve could affect the autonomic nervous system and gastrointestinal function. However, this study had no group to compare with. Future randomized project should address this issue.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.2
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• pp.85-93
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• 2019

Purpose : The purpose of this study was to investigate the effects of abdominal functional electrical stimulation on peak cough flow and forced vital capacity in patients with cervical spinal cord injury. Methods : The study examined 20 patients with cervical spinal cord injury. The subjects were randomly divided into two groups. All subjects performed conservative physical therapy for 30 minutes. The experimental group also underwent abdominal functional electrical stimulation for at least 20 minutes per day. Abdominal functional electrical stimulation was applied to the rectus abdominis muscle twice each day, three times a week, for four weeks. In all subjects, the peak cough flow was measured using a peak flow meter and forced vital capacity was assessed using a spirometer. Results : The experimental group showed a significant increase in peak cough flow and forced vital capacity in pre-post measurements (p<.05), while the control group showed a significant increase only in peak cough flow. Conclusion : These findings suggest that conservative physical therapy in combination with the abdominal functional electrical stimulation can improve peak cough flow and forced vital capacity in patients with cervical spinal cord injury.

• Physical Therapy Rehabilitation Science
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• v.8 no.3
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• pp.162-169
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• 2019

Objective: The purpose of this study was to investigate the conditions for the application of various plank exercises to people who require trunk stabilization by comparing trunk muscle activity according to the degree of hip abduction in the plank exercise. Design: Cross-sectional study. Methods: Twenty healthy participants voluntarily participated in this study and the plank exercise was performed under 5 conditions (two-legged support plank [TSP] with hip abduction, TSP with hip abduction of 15 degrees, TSP with hip abduction of 30, one-legged support plank [OSP] with hip abduction of 15 degrees, OSP with hip abduction of 30 degrees). In order to measure the trunk muscle activity according to the 5 conditions, surface electromyography was used. The electrical activities of the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles were measured during the 5 plank exercises. Subjects practiced each of the 5 conditions three times in random order and the average values were obtained. Results: In the OSP condition with 15/30 degrees of hip abduction, activities of the RA, EO, and IO were significantly greater than during the TSP (p<0.05). In the OSP with 30 degrees of hip abduction condition, activities of the left EO, IO were significantly greater than other plank exercise conditions (p<0.05). Conclusions: The plank exercise with hip abduction of 30 degrees and the OSP exercise can be suggested as an effective method to enhance the activity of the trunk oblique muscles.

• The Korean journal of sports medicine
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• v.36 no.4
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• pp.197-206
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• 2018

Purpose: This study analyzed the muscle activity changes induced by motions of reaching forward and chest expansion that were examined from the bilateral muscles with rectus abdominis, external oblique, multifidus, and longissimus thoracic using Pilates cadillac instrument. Methods: Nine young adult women, who have no musculoskeletal disorder and any of chronic diseases, were participated. Surface electromyography system was used for recording of all signals produced by muscles, and then normalized as percentage of maximum voluntary isometric contraction (%MVIC). The paired t-test and repeated measures of analysis of variance was performed. Results: Reaching-forward motion showed a higher muscle activity from non-dominant external oblique muscle than that of the chest-expansion motion. During both reaching-forward motion and chest-expansion motion, MVIC values collected from dominant side of external oblique muscle were shown a significantly lower than the values obtained from non-dominant side (p<0.05). Conversely, %MVIC values in external oblique muscle collected from dominant side showed a significantly higher than the values obtained from non-dominant side of the same oblique muscle (p<0.05). Reaching-forward motion was caused a higher %MVIC on non-dominant external oblique muscle than that of the chest-expansion motion (p<0.05). Regardless of dominant or non-dominant sides, external oblique muscle was shown the highest activation rate of all the other muscles during reaching forward action, and longissimus thoracic muscle was shown the highest activation rate of all the other muscles during chest expansion action. Conclusion: Reaching-forward motion is suitable for activating an external oblique muscle, and chest-expansion motion is an effective enough in activating of longissimus thoracic muscle.