• Archives of Plastic Surgery
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• v.39 no.6
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• pp.649-654
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• 2012

Background Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. Methods A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. Results Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 $cm^2$ (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was $98^{\circ}$ (range, $85^{\circ}$ to $115^{\circ}$). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). Conclusions Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.

• Physical Therapy Korea
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• v.17 no.3
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• pp.77-86
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• 2010

The purpose of this study was to investigate the variations in gait parameters in terms of the type of arm sling used in hemiplegic patients. Ten patients with hemiplegia and ten healthy adults participated in this study and walked at self-selected speeds on a GAITRite-instrumented carpet. The activities of the opposite shoulder girdle muscle including the latissimus dorsi, anterior deltoid, and posterior deltoid were simultaneously recorded using surface EMG during gait. They were randomly assigned a condition: without an arm sling, a single strap arm sling, a Harris hemi arm sling, a Rolyan humeral cuff arm sling, and a Bobath roll arm sling. The following gait variables were analyzed: the temporo-spatial parameters of velocity, step length, stride length, swing phase, stance phase, single support, step time and toe in/toe out. The statistical analysis was one-way ANOVA with repeated measures to compare the variation of each variable. In comparison of parameters in each trial in the hemiplegia group, the non-affected side stride length, single support, and toe in/toe out resulted in statistically significantly changes (p<.05). But without an arm sling group did not show any gait parameter differences with arm slings. This study found that several arm slings varied gait patterns in patients with hemiplegia and in healthy adults. In the EMG analysis, the Rolyan humeral cuff arm sling and the Bobath roll arm sling were higher muscle activity for the latissimus dorsi muscle than did the single strap ann sling. Further study should examine the problems that appeared in patients who worn arm slings by focusing on a larger number of subjects and by studying the variety of responses in more detail using an assessment tool that measures variation.

• Physical Therapy Korea
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• v.24 no.2
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• pp.1-8
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• 2017

Background: Individuals with spinal cord injury (SCI) rely on their upper limbs for body-lifting activity (BLA). While studies have examined the electromyography (EMG) and kinematics of the shoulder joints during BLA, no studies have considered foot position during BLA. Objects: This study compared the effects of different foot positions during BLA on the shoulder muscle activities, peak plantar pressure, knee flexion angle, and rating perceived exertion in individuals with SCI. Methods: The study enrolled 13 mens with motor-complete paraplegic SCI, ASIA (American Spinal Injury Association) A or B. All subjects performed BLA with the feet positioned on the wheelchair footrest and on the floor independently. Surface EMG was used to collect data from the latissimus dorsi, pectoralis major, serratus anterior, and triceps brachii. The peak plantar pressure was measured using pedar-X and the knee flexion angle with Image J. Borg's rating perceived exertion scale was used to measure the physical activity intensity level. The paired t-test was used to compare the shoulder muscle activities, peak plantar pressure, knee flexion angle, and rating perceived exertion between the two feet positions during BLA. Results: The activity of the latissimus dorsi, pectoralis major, serratus anterior, and triceps brachii and rating perceived exertion decreased significantly and the peak plantar pressure and knee flexion angle increased significantly when performing BLA with the feet positioned on the wheelchair footrest compared with on the floor (p<.05). Conclusion: These findings suggest that individuals with SCI may perform BLA with the feet positioned on the wheelchair footrest for weight-relief lifting to decrease the shoulder muscle activities and the rating perceived exertion and to increase the peak plantar pressure and the knee flexion angle.

• Archives of Plastic Surgery
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• v.43 no.6
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• pp.586-589
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• 2016

A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.1-6
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• 2001

Free flap transplantation demands meticulous microsurgical technique to cover the exposed vital structures which is important to restore and maintain functions of the extremities. From July 1992 through December 2000, 99 patients were received reconstructive microsurgery in the upper and lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The most common cause in the upper extremity was industrial accident, 8 cases of total 15 cases and in the lower extremity was traffic accident, 66 cases of total 84 cases. The most commonly involved site was thumb and finger, 8 cases of total 15 cases and in the lower extremity was leg, 65 cases of total 84 cases. In upper extremity, the wrap around free flap was carried out in 4 cases(4.0%), first dorsal metatarsal artery flap and lateral arm flap were 3 cases(3.0%) each in 15 cases and in lower extremity, latissimus dorsi myocutaneous flap were 23 cases(23.2%), gracilis 20cases(20.2%), and rectus abdominis muscle flap 18(18.2%) in 84 cases. Overall 89 cases(89.9%) of 99 cases were survived and maintained and revealed good cosmetic results.

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.792-795
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• 2007

Purpose: Scoliosis is a multifactorial disorder caused by genetic, biochemical, developmental, neuromuscular factors and causes complex deformities which include skeletal deformity, pain, cardiovascular dysfunction, motor function disorder. Until now, the treatment of scoliosis have been focused on orthopedic correction, preservation of cardiopulmonary and neurologic function. But recently, as aesthetic demands increases, the needs for the correction or improvement of the trunk and extremity contour does. So, the correction of soft tissue contour deformity can be a new concept for the treatment of scoliosis. Methods: We corrected a deformed contour with prefabricated silicone implant in a scoliosis patient who had been operated for orthopedic correction previously. Submuscular pocket was made under trapezius and latissimus dorsi muscle. Silicone implant was placed in the pocket and fixed to thoracolumbar fascia with sutures. Results: We had a satisfactory results for the correction of contour deformity. There was no significant complication. Conclusion: Silicone implant is a new trial for the correction of scoliosis contour deformity. This method is simple, safe and brings on satisfactory results.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.539-544
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• 2008

Purpose: There have been limited reports on breast reconstruction after excision of phyllodes tumor. This paper reports four patients who had immediate reconstruction of the breast following excision of phyllodes tumor. Methods: We retrospectively reviewed the medical records of 14 patients from March 2000 to March 2008. Clinical data were analyzed including age, presenting symptoms and signs, type of surgery and metastasis. Results: The mean age was 38.6 years. The mean follow-up period was 40.6 months. Reconstruction was performed with latissimus dorsi musculocutaneous flap in 3 patients and transverse rectus abdominis musculocutaneous flap in 1 patient. Other cases were covered with skin graft or primary repair. 2 local recurrent cases were noted. Conclusion: The breast affected by phyllodes tumor must undergo complete excision. Followed by mastectomy, immediate reconstruction of breast improved cosmetic results, and allowed a wider surgical excision margin of tumor.

• Korean Journal of Applied Biomechanics
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• v.16 no.4
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• pp.1-12
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• 2006

This research was to know EMG tendency on increasing record in snatch weightlifting. In order to perform this research, we choiced 3 man national weightlifters, EMG analysis were executed on 8 major muscle(Latissimus Dorsi, Trapezius, Anterior Deltoid, Posterior Deltoid, Gastrocenemius, Vastus Medialis, Erector spinae, Abdominal). First trial record of athletics is 80% of each maximal record and increase the $5{\sim}10kg$ gradually. In this study, EMG signal scale of all muscle except posterior Deltoid muscle don't increased according to increasing the barbell weight, This showed a difference between general recognition and experiment result. In posterior Deltoid muscle, EMG signal scale increased according to increasing the barbell weight. It was assumed that EMG signal of protagonist shows possibility of linear increasing if motion have a consistency. It was assumed that In present, In order to increase one's record to $5{\sim}10kg$, Motion consistency training is more effective training method than increasing the muscle force.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.271-280
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• 2005

There are various types of flap in head and neck reconstruction. We chose the appropriate flap considering the indication and patient's condition. In case of conventional flaps, its type is decided according to the reconstruction site. In other words, the types of considerable flaps are limited in a way. But, perforator flaps can reduce donor limitation and harvest flaps depending on the condition of the recipient. Therefore, the flap is very useful for the head and neck reconstruction needed for 2-dimensional or 3-dimensional reconstruction. We report the 29 cases of perforator-based flap including 8 cases of latissimus dorsi perforator free flap, 5 thoracodorsal perforator free flap, 4 anterolateral thigh perforator free flap, 3 peroneal osteocutaneous perforator free flap and 9 submental perforator island flap for the head and neck reconstruction. Free flaps include 2 cases of chimeric pattern, 7 controlled resurfacing pattern, 4 3-D pattern, 3 dermoadiposal pattern, 1 folded pattern and 3 osteocutaneous pattern. The flaps were successfully used for the head and neck reconstruction. But one patient died during a follow up period because of the recurrence of tumor. Various perforator flaps(island/free pattern) can be highly competitive to the conventional flaps in the head and neck reconstruction, considering a thin character for resurfacing, more flexible and versatile option, variable composition, long pedicle with donor structures saved, and less prominent donor morbidity.

• Archives of Plastic Surgery
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• v.47 no.6
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• pp.619-621
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• 2020

This article portrays the authors' clinical experience of a complex case of lower extremity reconstruction using a recycled pedicle from 10 years old free latissimus dorsi musculocutaneous flap to supply a new free anterolateral thigh flap for proximal tibia wound defect reconstruction. It provides clinical evidence that muscle neovascularization occurs and supports the dogma peripheral tissue neovascularization. This case stipulates that recycling of pedicle is feasible, when used with appropriate strategy and safety and also provides evidence for the long-term survival of greater saphenous vein grafts in lower extremity reconstruction.