• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.141-145
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• 2002

Rectus abdominis muscle free flap is widely used for breast reconstruction and soft tissue defect in lower leg but donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. Recently, to minimize donor-site morbidity, there has been a surge in interest in deep inferior epigastric perforator(DIEP) free flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. Between August of 1995 and September of 2002, topographic investigation of DIEP was performed during the elevation of 97 cases of TRAM free flap and 5 cases of DIEP free flap. There were 84 cases of breast reconstructions, 12 cases of lower leg reconstructions, and 6 cases of head and neck reconstruction. We could observe total 10 to 12 perforators on each rectus abdominis muscle below umbilicus. Among these, the numbers of large perforators(>1.5mm of diameter) were mean 2.1 in lateral half of rectus abdominis muscle, mean 1.2 in medial half, and mean 0.5 in linea alba and paramedian. DIEP free flap provides ample amount of well vascularized soft tissue without inclusion of any rectus abdominis muscle and fascia and minimizes donor-site morbidity. One perforator with significant flow can perfuse the whole flap. For large flap, a perforator of the medial row provides better perfusion to zone-4 than one of lateral row and, if diameter of perforator is small, $2{\sim}3$ perforators can be used. According to the condition of recipient-site, thin flap can be harvested. As DIEP free flap has many advantage, perforator topography will be useful in increasing clinical usage of DIEP free flap.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.130-138
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• 1999

The lower extremity injuries are extremely increasing with the development of industrial & transportational technology. For the lower extremity injuries that result from high-energy forces, particularly those in which soft tissue and large segments of bone have been destroyed and there is some degree of vascular compromise, the problems in reconstruction are major and more complex. In such cases local muscle coverage is probably unsuccessful, because adjacent muscles are destroyed much more than one can initially expect. Reconstruction of the lower extremity has been planned by dividing the lower leg into three parts traditionally The flaps available in each of the three parts are gastrocnemius flap for proximal one third, soleus flap for middle one third and free flap transfer for lower one third. Microvascular surgery can provide the necessary soft tissue coverage from the remote donnor area by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde flow flaps are well established in island flaps. Retrograde flow anastomosis could not interrupt the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. During 5 years, from March 1993 to Feb. 1998, we have done 68 free flap transfers in 61 patients to reconstruct the lower extremity. From analysis of the cases, we concluded that for the reconstruction of the lower extremity, free flap transfer yields a more esthetic and functional results.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.4
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• pp.407-417
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• 2013

The one of peri-implant soft tissue problems seen during the maintenance phase of implant therapy is an inadequate zone of keratinized tissue. Keratinized tissue plays a major role around teeth and dental implants, helping in maintaining and facilitating oral hygiene. A free gingival graft (FGG) is chosen to correct the soft tissue defects and provide optimal peri-implant health in order to increase the long-term prognosis of the implant reconstruction. However, the patient treated with FGG has pain and discomfort on donor site such as palate. It is also technically demanding, time consuming, and the color match of the tissue is often less than ideal. An apically positioned flap (APF) is selected for increasing the keratinized tissue simply while or after the second stage implant surgery. This case report shows successfully increasing the width of peri-implant kenratinized tissue through APF procedure on small site of dental implant instead of FGG.

• Journal of the Korean Geosynthetics Society
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• v.5 no.4
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• pp.19-25
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• 2006

To examine the general features of a sand-clay composite triaxial test by making specimen varying ratios of diameters (dw) of sand columns that are installed on the soft ground as drains to diameters (de) of drain zone so called drainage space ratio (n=de/dw), densities of the granular columns, and strength of soft soils round around. I also conducted a test to research the reinforcement ability and effects of the ground when the granular columns are wrapped with supplementary materials such as geotextile. The results of the triaxial compression test showed that the shear strength increase is much big when the granular columns are wrapped with supplementary materials, while the shear strength increases as the diameter and density of the granular column increase in general. Also the drainage space ratio shows a distinct increase just below 3 and a similar shear behavior to sand is appeared. The pore water pressure coefficient decreases as the drainage space ratio decreases, however, when the drainage space ratio is less than 3~4, it declines significantly as shown in the results of shear behavior.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.4
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• pp.289-295
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• 2020

Improving implant esthetics is very difficult, especially in cases where unaesthetic problems are related to implants in the maxillary anterior dentition. A 69-year old male patient was referred by a prosthodontist for periodic pus discharge and an unaesthetic implant prosthesis (maxillary right lateral incisor). The implant was placed too deeply and showed soft tissue volume deficiency and a long clinical crown. After a clinical and radiographic examination, implant submergence and alveolar ridge augmentation were performed to enhance the aesthetics instead of an explantation. The treatment plan was as follows: extraction the adjacent teeth with tooth mobility, secondary caries, and poor prognosis; placement an additional dental implant with hard and soft tissue grafting; fabrication a fixed bridge using implant abutments. A fixed esthetic prosthesis using implants was fabricated, and the patient was satisfied with the prosthesis. A ridge augmentation with implant submergence may be an alternative for solving the problems of unaesthetic implant restorations in the esthetic zone.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.586-592
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• 2023

Background One-stage reconstruction with "thin perforator flaps" has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is a commonly utilized flap in breast reconstruction (BR). The purpose of this study is to present the versatility of DIEP flaps for the reconstruction of large defects of the extremities. Methods Patients with large tissue defects on extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included. They were minimally followed up for 36 months. We analyzed the etiology and location of the soft tissue defect, flap design, anastomosis type, outcome, and complications. We also considered the technical differences in the DIEP flap between breast and extremity reconstruction. Results Overall, six free DIEP flaps were included in the study. The flap size ranged from 15 × 12 to 30 × 16 cm². All flaps were transversely designed similar to a traditional BR design. Three flaps were elevated with two perforators. Primary closure of the donor site was possible in all cases. Five flaps survived with no complications. However, partial necrosis occurred in one flap. Conclusion A DIEP flap is not the first choice for soft tissue defects, but it should be considered for one-stage reconstruction of large defects when the circulation zone of the DIEP flap is considered. In addition, this flap has many advantages over other flaps such as provision of the largest skin paddle, low donor site morbidity with a concealed scar, versatile supercharging technique, and a long pedicle.

• Geomechanics and Engineering
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• v.36 no.6
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• pp.563-573
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• 2024

In this study, various countermeasures used to mitigate tunnel deformations due to nearby multi-propped basement excavation in soft clay are explored by three-dimensional numerical analyses. Field measurements are used to calibrate the numerical model and model parameters. Since concrete slabs can constrain soil and retaining wall movements, tunnel movements reach the maximum value when soils are excavated to the formation level of basement. Deformation shapes of an existing tunnel due to adjacent basement excavation are greatly affected by relative position between tunnel and basement. When the tunnel is located above or far below the formation level of basement, it elongates downward-toward or upward-toward the basement, respectively. It is found that tunnel movements concentrate in a triangular zone with a width of 2 H_e (i.e., final excavation depth) and a depth of 1 D (i.e., tunnel diameter) above or 1 D below the formation level of basement. By increasing retaining wall thickness from 0.4 m to 0.9 m, tunnel movements decrease by up to 56.7%. Moreover, tunnel movements are reduced by up to 80.7% and 61.3%, respectively, when the entire depth and width of soil within basement are reinforced. Installation of isolation wall can greatly reduce tunnel movements due to adjacent basement excavation, especially for tunnel with a shallow burial depth. The effectiveness of isolation wall to reduce tunnel movement is negligible unless the wall reaches the level of tunnel invert.

• Journal of Korean Society of Coastal and Ocean Engineers
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• v.17 no.3
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• pp.129-137
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• 2005

In this study, we developed a model to simulate the interaction between sediment and the overlying water. The model deals with water-sediment interaction in terms of the sedimentation of organic detritus from the pelagic zone into the benthic zone and the release of nutrients occurring in the reverse direction. The model was tested and verified by comparing the predicted release rates of phosphorus from the sediment in Osaka Bay with actual observed values. The results accurately reproduced the seasonal change in release rates. The results well represented seasonal change of the release rates. A long-term prediction of water and sediment quality was performed for the period from 1950 to 1999. Nutrient loads from land and the boundary conditions of 3-D baroclinic flows were season-adjusted. The model accurately reproduced the changing trends in phosphorus, nitrogen, and COD concentrations in Osaka Bay over a long period of time.

• Geomechanics and Engineering
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• v.15 no.5
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• pp.1029-1038
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• 2018

A superposition-iteration (S-I) model is proposed to simulate the jet grouting pre-reinforcing impact for a shallow-buried tunnel. The common model is deduced by theoretical (force equilibrium) analysis and then transformed into the numerical formulation. After applying it to an actual engineering problem, the most obvious deficiency was found to be continuous error accumulation, even when the parameters change slightly. In order to address this problem, a superposition-iteration model is developed based on the basic assumption and superposition theory. First, the additional deflection between two successive excavation steps is determined. This is caused by the disappearance of the supporting force in the excavated zone and the soil pressure in the disturbed zone. Consequently, the final deflection can be obtained by repeatedly superposing the additional deflection to the initial deflection in the previous steps. The analytical solution is then determined with the boundary conditions. The superposition-iteration model is thus established. This model was then applied and found to be suitable for real-life engineering applications. During the calculation, the error induced by the ill-conditioned problem of the matrix is easily addressed. The precision of this model is greater compared to previous models. The sensitivity factors and their impact are determined through this superposition-iteration model.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.27-30
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• 2009

Purpose: Recently, replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. However the replantation of fingertip in adults is a well-established procedure, but the replantation in infant or child is still uncommon. Therefore we present one case of replantation of the fingertip of the small finger in 12-months-old patient. Methods: We experienced a 12-months-old male amputation of small finger. It had been amputated completely at the level of Zone I by Yamano classification. Replantation was performed using the arteryonly technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration. Venous drainage was provided by an external bleeding method with partial nail excision and repaired margin for approximately 7 days. Results: We were performed replantation in infant with only-arterial anastomosis successfully, result in good recovery of aesthetic and functional outcome. Conclusion: In conclusion, although fingertip injury was difficult to replantation in infant and child, we must try it. Because of its functional and cosmetic advantage.