• Title/Summary/Keyword: medical approach

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Approach to Internal Mammary Vessel without Rib Cartilage Resection in Free Abdominal Flap Breast Reconstruction (유리 복부 피판 유방재건술에서 늑연골을 절제하지 않는 Internal mammary vessel로의 접근법)

  • Eom, Jin Sup;Sun, Sang Hoon;Kim, Tae Gon;Lee, Taik Jong
    • Archives of Plastic Surgery
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    • v.36 no.6
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    • pp.750-754
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    • 2009
  • Purpose: The thoracodorsal vessels have been the standard recipient vessels for the majority of surgeons performing free abdominal flap breast reconstructions. Recently, the internal mammary vessels have been recommended as the first - choice recipient vessels for microvascular breast reconstruction. To approach the internal mammary vessel, 3rd or 4th rib cartilage excision is needed, but this method has some demerits - vessel injury, post operative pain and post operative chest hollowness. So, authors propose the approach method to the internal mammary vessel through intercostal space without rib cartilage resection. Methods: From November, 2008 to May, 2009, 13 patients underwent free abdominal flap breast reconstruction with approach to the internal mammary vessel through intercostal space without rib cartilage resection. Results: The mean patient age was 41.8 years, and the mean height was 159.3 cm. 11 patients underwent immediate breast reconstruction. Free DIEP flap reconstruction was performed in 7 patients, Free TRAM flap was performed in 5 patients, and Free SIEA flap was performed in 1 patient. Except 1 case, approach to the internal mammary vessel was took through 3rd intercostal space, and all width of intercostal space exceeded 1 cm. Conclusion: In the authors' experience, use of approach to the internal mammary vessels without rib cartilage resection method is safe and reliable to overcome demerits of rib cartilage resection method.

Strategies for Structuring Health Systems Science Curriculum in the Korean Medical Education: A Study Based on an Analysis of the Domestic Status of Health Systems Science Education and Case Studies of US Medical Schools (한국형 의료시스템과학 교육과정 구성 전략: 국내 의료시스템과학 교육 현황과 미국 의과대학 사례분석을 중심으로)

  • Yoo Mi Chae;Young Mee Lee;Sun Hee Shim
    • Korean Medical Education Review
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    • v.25 no.3
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    • pp.198-211
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    • 2023
  • Health systems science (HSS) is recognized as the third pillar of medical education. alongside basic and clinical sciences. Today's physicians must also be systems thinkers who are able to discern how social, economic, environmental, and technological forces influence clinical decision-making. This study aimed to propose strategies for structuring an HSS curriculum that is tailored to the Korean healthcare and medical education context. First, the authors of this study conducted a survey to identify the present curricular contents of HSS related education at Korean medical schools. Second, a needs assessment was performed to determine the necessity of HSS competencies, as well as the prerequisites for the seamless integration of HSS into the existing curriculum. Third, literature reviews on HSS education at 14 US medical schools and expert consultations was conducted. We would like to propose a set of strategic approaches, classified into two levels: comprehensive and partial restructuring of the current medical curriculum to incorporate HSS. The partial restructuring approach entails a gradual, incremental incorporation of HSS content, while maintaining the current curricular structure. In contrast, a complete overhaul of the curriculum may be ideal to build HSS as the third pillar of medical education, but its feasibility remains relatively limited. The partial reorganization approach, however, has the advantage of being highly feasible. Collaborative efforts between professors and students are imperative to collectively devise effective methods for the seamless integration of HSS into the existing curriculum.

Extended Application of Endoscopic Repair for Frontal Sinus Fractures (전두동 골절에서 내시경적 치료의 확대 적용)

  • Jeong, Jae-Yeon;Lim, So-Young;Pyon, Jai-Kyong;Bang, Sa-Ik;Oh, Kap-Sung;Mun, Goo-Hyun
    • Archives of Plastic Surgery
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    • v.37 no.5
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    • pp.613-618
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    • 2010
  • Purpose: The coronal approach for repair of frontal sinus fractures is associated with significant adverse sequelae including a long scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. To minimize these complications, an endoscopic approach for repair of frontal sinus fractures was developed. The authors now present the results of an endoscopy-assisted approach for the treatment of frontal sinus fractures. Methods: From 2002 to 2009, five patients with frontal sinus fracture underwent endoscopic repair. Two slit incisions were placed in the scalp, and one or two stab incisions directly over the fractures were placed in the forehead. After subperiosteal dissection, fracture segments were reduced under direct vision and fixed with microplates or fibrin glue. Results: All patients had good cosmetic results and remained free of sinus complaints. There were no perioperative complications reported. Conclusion: Endoscopic repair of frontal sinus fractures is an efficacious technique that significantly reduces patient morbidity. A relatively wide range of anterior table fractures can be reduced using an endoscope. In cases of complicated comminuted fractures, fibrin glue helps to achieve satisfactory endoscopic reduction. Endoscopic repair is an alternative treatment for various anterior table fractures of the frontal sinus.