• Title/Summary/Keyword: decubitus

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Innovation in the planning of V-Y rotation advancement flaps: A template for flap design

  • Dolen, Utku Can;Kocer, Ugur
    • Archives of Plastic Surgery
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    • v.45 no.1
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    • pp.85-88
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    • 2018
  • Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

Effect of Posture on the Distribution of Pulmonary Ventilation in Patients with Increased Closing volume (폐쇄용적(Closing Volume)이 증가된 만성 폐질환 환자에서 체위에 따른 폐환기량의 변화)

  • Kim, Young-Tae;Kim, Mee-Kyung;Lim, Chae-Man;Koh, Youn-Suck;Kim, Woo-Sung;Ryu, Jin-Sook;Lee, Myung-Hae;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.6
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    • pp.631-637
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    • 1993
  • Background: In normal adults, ventilation is uneven and greater in the base than the apex of the lung in tidal volume breathing. However infants have fragile chest wall and reduced elastic recoil, resulting in easy closure of peripheral airways especially in the dependent portion of the lung. So ventilation in infants is greater in the apex than the base of the lung. We assumed that in adults whose closing volume is increased, dependent portion could be easily collapsed during tidal breathing and ventilation could be greater in the uppear than than the lower portion of the lung. Methods: We measured spirometry and closing volume(CV) in normal controls and in patients with chronic lung disease. Also we measured fractional distribution of ventilation at supine, left lateral and right lateral decubitus with $^{133}Xe$ ventilation scan in normal controls, patients with normal closing volume and patients with increased closing volume. Results: The subjects consisted of 7 normal controls(mean $age{\pm}SD$, $62.9{\pm}6.1$ years). 6 patients with normal CV($62.8{\pm}8.2$ years) and 7 patients with increased CV($63.0{\pm}15.3$ years). 1) Normal controls have mean(${\pm}SD$) FVC $104{\pm}11%$ of predicted value, $FEV_1\;120{\pm}16%,\;FEV_1/FVC\;112{\pm}5%$ and CV $86.9{\pm}12.5%$. Patients with normal CV have FVC $62{\pm}11%,\;FEV_1\;54{\pm}17%,\;FEV_1/FVC\;84{\pm}23%$ and CV $92.6{\pm}15.5%$. Patients with increased CV, have FVC $53{\pm}9%,\;FEV_1\;38{\pm}13,\;FEV_1/FVC\;69{\pm}16%$ and CV $176.1{\pm}36.6%$, CV was significantly different between two patient groups(p<0.02) 2). In normal controls mean fractional ventilation to left lung was $48.1{\pm}5.3%$ at supine, $54.1{\pm}9.8%$ at dependent and $40.9{\pm}6.5%$ at left uppermost position. In patients with normal CV mean fractional ventilation to left lung was $44.6{\pm}2.1%$ at supine, $59.7{\pm}5.6%$ at left dependent and $31.7{\pm}8.3%$ at left uppermost position. In patients with increased CV mean fractional ventilation to left lung was $48.7{\pm}4.5%$ at supine, $41.7{\pm}6.6%$ at left dependent and $60.9{\pm}15.7%$ at left uppermost position. In normal controls and patients with normal CV, ventilation to left lung at left dependent position tends to be higher than that at supine position but without statisitical significance and it was significantly lower at left uppermost than at left lung dependent position. In patients with increased CV, ventilation to left at left dependent position tends to be higher than that at supine position but without significance and it was significantly higher at left uppermost than that at left dependent position. Conclusion: These data suggest that in patients with increased CV ventilation to one side of lung could be higher at uppermost than at dependent position on lateral decubitus during tidal breathing and this fact should be taken into account in positioning of patients with unilateral lung disease.

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A Study of the Evaluation of the Spinal Cord Injuries (척수 손상 환자에 관한 실태 조사)

  • Kim, Myung-Hoon
    • Journal of Korean Physical Therapy Science
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    • v.3 no.2
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    • pp.1011-1019
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    • 1996
  • The incidence of spinal cord injury increase due to traffic accident, industrial accident and leisure sports. Spinal cord injury damages motor and sensory function below the injury level, also affects autonomic functions associated with voiding and defecation. Sexual dysfunction and psychosocial, vocational maladaptations are also some of the unwanted consequences of injury. The purpose of this study is look for means to prevent and to manage complications in spinal cord injury through investigation and analysis. The subjects of this study in spinal cord injured patients were admitted to the department of physical therapy, Kwangju christian Hospital, Nam Kwang Hospital, Chun Nam university Hospital and Cho Sun university Hospital, from April, 1, 1995 to March, 31, 1996. The results are as follows: 1. The subjects comprised 96 cases of spinal cord injury, ranging from 17 to 85(mean-40.8 yrs) and included 72 males and 24 females. Among these patients, 58 were cervical injury, 20 were thoracic injury and 18 were lumbar injury. 2. As for a major causative of spinal cord injury were traffic accident(59.4%), fall down (27.1 %), and motocycle(4.2%).. 3. The bladder control were taken by indwelling cathetar(41.7%), Crede maneuver(37.5%) and self voiding(16.7%). The bowel control were taken by all aid(61.5%), assitance(32.3%) and self defecation(6.2%). 4. Possible of sexual function were 35 cases (47.9%). 5. The device of transfer used wheel chair(69.8%) and bed(16.7%). 6. The patients with higher cord lesion got more serious pain than lower cord lesion. Also the patients with higher cord lesion got a serious spasticity. 7. The incidence of decubitus ulcer among 96 patients were in case 46(47.9%). The largest group of the pressure sore sites were sacral portion(82.0%), less than 1 month of onset occured a large numbers(50%). Incidence of pressure sore by spasticity occured many patients in case of mild or moderate. Incidence of pressure sore by pain occured many patients in case of severe pain.

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The Study of Relationship among Low Back Pain, Lumbar Lordosis, Obesity and Sasang Constitution (사상체질분류검사지(QSCC) II를 통한 요통환자의 질병친화도 및 요추전만각, 비만도와의 상관성 연구)

  • Lee, Byeong-Yee;Lee, Gil-Jae;Song, Yun-Kyung;Lim, Hyung-Ho
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.3 no.2
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    • pp.69-76
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    • 2008
  • Objectives : The purpose of this study is to investigate the relationship among low back pain, lumbar lordosis, obesity and Sasang constitution. Methods : The researcher discriminated the Sasang constitutions of those observed-the inpatient-who were treated from March to May 2008 for low back pain. X-ray were taken in lateral decubitus and the lumbar lordotic angles(LLA) were measured. BMI were measured. This results were statistically analyzed using SPSS 12.0. Results : 1. Among the 31 subjects, distributional rate of Soyangin, Taeumin, and Soeumin were 48.4%, 29.0% and 22.6%. 2. The result showed a significant difference with the Sasang constitution from $\ll$Dongy Suse Bowqn$\gg$. 3. The result showed a difference with the Sasang constitution from the existing result from OSCC II. 4. There was no significant relations between each constitutions and lumbar lordotic angle. 5. There was significant relations between each constitutions and BMI. Conclusions : In this study, The rate of Soyangin, among the low back pain patients, was higher. And the average of BMI was higher in Taeumin.

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Two cases of Pressure sore treated by Talcum(滑石) powder (욕창(褥瘡)환자를 활석분(滑石粉)으로 치료(治療)한 치험 2예)

  • Yang, Mi-Ra;Choi, Jin-Young;Shin, Hak-Soo;Jung, Yong-Jun;Kim, Kwan-Sik;Seo, Kwan-Soo;Kim, Dong-Woung;Shin, Sun-Ho;Cho, Gwon-Il
    • The Journal of Internal Korean Medicine
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    • v.22 no.4
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    • pp.709-715
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    • 2001
  • Pressure sore(Decubitus ulcer) is an area of ulceration and necrosis of the skin and underlying tissues occurring over the body prominence such as the sacrum, greater trochanter, scapula, lateral malleolus, thoracic spine and heels after prolonged or often repeated pressure. These days incidence of pressure sore have been increased because of the many population of the old, traffic accidents and cerebral vascular disease. But the treatment was not confirmly established. As for treatment, we used Talcum powder for 10 days in case 1 and 6 days in case 2. The patients were improved within 14 days after treatment in case 1 and 10 days in case 2.

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Management of the PCL Injuries (후방 십자 인대 손상의 치료)

  • Jung, Young Bok;Jung, Ho Joong
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.1
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    • pp.25-32
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    • 1998
  • The distinction between isolated and combined injuries is crucial both for treatment and prognosis. For most combined injuries, surgical treatment continues to be favored over nonoperative treatment. It is generally agreed that isolatel PCL injuries do well without surgery. There has been an interest by many authors to fix the graft directly to the posterior aspect of the tibia(tibial inlay). With this procedure, tibial graft fixation will be more direct and theoretically reduce the bending effects of the graft with a fixation site far away from the tibial insertion. Modified tibial inlay technique, which is the posterior approach does not require the patient to be in the prone or lateral decubitus position during the operation. Use of a double-bundle reconstructive technique is attractive and has been performed by some surgeons. At this time, this procedure is still being investigated and should not be routinely used in the clinical setting until studies have indicated an advantage over current single-bundle techniques. However theologically, double-bundle reconstructive technique is more useful in severe posterior unstable knee. Recent advances have increased our knowledge of the anatomy and mechanical characteristics of the PCL. Basic science research has further increased our awareness of the interaction of the posterolateral structures with the PCL. To achieve restoration of normal posterior laxity, it is critical to address the posterior as well as the postero-lateral structures. Surgical treatment is often complex and requires a wide range of surgical techniques and skills to treat associated injuries. When the PCL is reconstructed, most surgeons choose to reconstruct the anterolateral component using a graft of sufficient size and strength. The initial postoperative rehabilitation should be addressed cautiously in an effort to avoid excessive forces on delicate repairs and reconstructions in these complex injuries. Further research is necessary to evaluate new surgical approaches such as double-bundle reconstructions and tibial inlay techniques as well as improved techniques for capsular and collateral ligament injuries.

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Pressure Ulcer preventive intervention and risk factors for pressure ulcers : A review of the literature (욕창예방을 위한 중재와 영향요인 : 체계적 문헌고찰)

  • Yun, Haesun;Park, Jeeyeon
    • Journal of Digital Convergence
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    • v.18 no.2
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    • pp.323-331
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    • 2020
  • This study was to perform a systematic review to examine pressure ulcer preventive intervention and risk factors. PRISMA flow diagram in accordance with the selection process of this research was done. The literatures were retrieved from domestic and international study from 2010 to June, 2019. A total of 30 literatures were selected according to the selection criteria of this study. The literatures were searched electronically using the search engine with the key words of 'pressure ulcers', 'bedsore', 'decubitus ulcers', 'intervention', 'prevention'. The results of this study suggest that mediation with position change and pressure reduction device reduced the incidence of pressure sores and was important for prevention. Based on the results of this study, we provide basic data for preventive intervention of pressure ulcers that are appropriate for each medical institution.

Breast Reconstruction with Superior Gluteal Artery Perforator Flap in Asian (동양인에서 위볼기동맥 천공지판을 이용한 유방재건)

  • Jeong, Woo Shik;Lee, Taek Jong;Eom, Jin Sup
    • Archives of Reconstructive Microsurgery
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    • v.22 no.1
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    • pp.7-12
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    • 2013
  • Purpose: Breast reconstruction with lower abdominal tissue can produce the best outcome with acceptable rates of long-term complication. However, for cases in which sufficient abdominal tissue is not available, an superior gluteal artery perforator (SGAP) flap can be considered as the next option for autologous breast reconstruction. Materials and Methods: Among a total of 63 women who underwent breast reconstruction with free autologous tissue transfer from July 2010 to April 2011, SGAP flap was performed for four patients. In two cases, patients did not have enough abdominal tissue for sizable breast reconstruction. In another case, the patient had a long abdominal scar due to donor hepatectomy of liver transplantation. In the last case, which was a revisional case after radiation necrosis of a previous pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, a large amount of healthy skin and soft tissue was needed. SGAP flap was elevated in lateral decubitus position. The internal mammary vessels were used for recipient vessels in all cases. Results: Breast reconstruction was performed successfully in all four cases without flap loss. Donor site complication was not observed, except for one case of seroma. The shape of the reconstructed breast was satisfactory in all patients. Conclusion: SGAP flap is an excellent alternative option for the TRAM or deep inferior epigastric artery perforator flap for breast reconstruction. In terms of narrower width, harder consistency of soft tissue, and shorter pedicle, it is clear that the SGAP flap is less competent than the TRAM flap. However, in cases where abdominal tissue is not available, SGAP flap is the only way of providing a large amount of healthy tissue.

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A Study of the Intraocular Pressure of Korean Youth (한국인 청년의 안압 측정)

  • Kim, Sang-Moon
    • Journal of Korean Ophthalmic Optics Society
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    • v.11 no.2
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    • pp.91-97
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    • 2006
  • The intraocular pressure for Korean youth were measured by using tonometer (AT555-Reichert). The relative frequency distributions of intraocular pressures have been studied for samples of 1,027 persons(475 males, 552 females). The most commonly recorded IOP for both men and women was around 14.5mmHg and 17.5mmHg, respectively. They were in the range of 7 to 23mmHg(males) and 7 to 22mmHg(females). The median pressure(cumulative frequency=0.5%) is 13.0~16.5mmHg for males and 16.5~18.5mmHg for females, so the values for females are slightly higher than males. The mean pressure is 15.2mmHg for males and 15.8mmHg for females, respectively. The 98% of population was in the range of the normal IOP. There are long-term diurnal variation in mean intraocular pressure and the IOP was decreased as a function of time from morning to night. The measured IOP was affected by several factors: exercise made to decrease the IOP and tight collars, dark places and posture of decubitus position got to elevate the IOP.

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Effect of Symmetrical Reciprocal Pattern of Scapula and Pelvis in PNF Concept on the Gait Speed and Balance of thePatients with Hemiplegia (PNF Concept중 Scapula and Pelvis의 Symmetrical Reciprocal Pattern이 Hemiplegia환자의 보행속도와 균형감각에 미치는 효과)

  • Maeng, Gwan-Cheol;Baek, Sun-Young
    • PNF and Movement
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    • v.13 no.2
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    • pp.73-80
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    • 2015
  • Purpose: The purpose of this study was to determine the effect of symmetrical-reciprocal pattern of scapula and pelvis exercises using proprioceptive neuromuscular facilitation (PNF) on gait speed and balance in patients with hemiplegia. Methods: Among the adult patients with hemiplegia that were hospitalized at Michuhol Rehabilitation Center after being diagnosed with stroke, 10 that were capable of independent walking for more than five minutes and that understood and cooperated with the therapy and test methods of this research, were selected as subjects. The therapy was implemented based on the concept of PNF, and it was performed on a low mat and a height-adjustable mat, as proscribed by the fundamental procedure for PNF. Symmetrical-reciprocal pattern of scapula and pelvis exercises were applied to the patients in the decubitus position. The therapy scheme included stabilizing reversals, rhythmic stabilization, and a combination of isotonics, rhythmic initiation, and dynamic reversals. To investigate gait speed and body trunk mobility before and after the symmetrical-reciprocal pattern of scapula and pelvis exercises were applied, walking speed for a distance of 10 m was measured and balance was tested based on the Berg-Balance scale test table. The Berg-Balance scale test was performed by one therapist to minimize any error that could occur from the subjective evaluation method used by therapists. Results: Gait speed increased by 8.97 seconds after applying the symmetrical-reciprocal pattern of scapula and pelvis exercises using the concept of PNF, showing a significant difference (p<0.01). However, balance showed no significant difference after the therapy (p>0.14). Conclusion: Exercise therapy that uses the symmetrical-reciprocal pattern of scapula and pelvis with the concept of PNF can be said to be a useful therapeutic technique that can enhance the walking speed of patients with hemiplegia.