• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.40-43
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• 2009

Purpose: Extensive midface defect following total maxillectomy with orbital exenteration and cheek skin resection should be three dimensionally reconstructed with a large flap that have a sufficient volume of tissue and multiple skin islands. We describe our transverse rectus abdominis myocutaneous(TRAM) free flap with three skin islands which was successfully used in this situation. Methods: A 58-year-old man was performed enbloc total maxillectomy including orbital contents and wide cheek skin because of invasive maxillary squamous cell carcinoma. He was immediately reconstructed with TRAM flap that was designed not vertical but transverse fashion for providing sufficient skin area. Also, deepithelialization procedure making for multiple skin islands was done in flap insetting period when appropriate modification according to the intraoperative situation was possible. Dead space was completely obliterated by bulky muscular tissue, and three skin islands were used for lining of lateral nasal wall, palatal surface, and cheek skin restoration. Results: Postoperative course was satisfying. Maintaining of proper ipsilateral nasal airway, loss of rhinolalia and oronasal regurgitation of food particles, and restoration of cheek contour were successfully obtained. Conclusion: We report clinical experience of threedimensional reconstruction using free TRAM flap after total maxillectomy with orbital exenteration.

• Physical Therapy Korea
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• v.14 no.4
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• pp.14-20
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• 2007

To improve abdominal muscles strengthening, double straight leg lowering (DSLL) has been widely used in physical therapy, fitness program, and athletic program. The purpose of this study was to investigate the effects of the lumbar stabilization maneuver with a pressure biofeedback unit on the muscle activity of rectus abdominis (RA), external oblique (EO), and internal oblique (IO) during DSLL. Fourteen healthy young men were recruited from university population. The electromyography (EMG) activity was recorded from the RA, EO, and IO of both sides. The normalized EMG activity was compared using a paired t-test. The study showed that EMG activity in the RA, EO, and IO was significantly higher during DSLL with lumbar stabilization (DSLL-LS) compared to performed DSLL (p<.05). These results suggest that DSLL-LS is recommended as an effective method for strengthening exercise for the abdominal muscles.

• The Journal of Korean Physical Therapy
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• v.29 no.3
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• pp.135-141
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• 2017

Purpose: This study was to identify the anticipatory postural adjustment (APA) mechanism which is represented by the onset time of trunk muscles and the displacement of the center of pressure (COP) according to the different base of support (BOS) during upper extremity movement. Methods: Thirty healthy subjects (14 males, 16 females) participated in this study. The movement was performed for 10 trials during each of various BOS (shoulder - width double leg stance, narrow base double leg stance, tandem stance, non-dominant single leg stance) at the 1.2 Hz frequency. Electromyography was used to measure muscle onset time and biorescue was used to measure characteristics of the displacement of COP. Surface bipolar electrodes were applied over the right deltoid anterior, right latissimus dorsi, both rectus abdominis, both internal oblique and both erector spinae. The data were analyzed by repeated one-way ANOVA and Duncan's post hoc test. Results: The study has revealed following. There were significant differences with muscle onset time in each BOS (p<0.01). There were significant differences in characteristics of the COP in each BOS (p<0.01). Conclusion: The study found that the more narrowed the basis requires the more rapid anticipatory postural control in contralateral postural muscle when the upper extremity movement is performed.

• PNF and Movement
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• v.15 no.3
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• pp.217-226
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• 2017

Purpose: The purpose of this study was to determine the effects of a modified abdominal draw-in maneuver on trunk stability and functional capacity as well as pain in patients with chronic low back pain. Methods: The study included 3 patients with chronic low back pain who volunteered to participate. The modified abdominal draw-in maneuver included a posterior pelvic tilt, a traditional abdominal draw-in maneuver, and a vibration sensory feedback device. Voluntary abdominal contraction using the vibration sensory feedback device was performed by the subjects for more than 1 hour per day, 5 times per week, for 6 weeks along with common low back pain treatment. Electromyographic signals in the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES) muscles were measured to compare muscle activation. The degree of pain was measured using the visual analogue scale (VAS), and functional capacity was measured using the Korea Oswestry Disability Index (K-ODI). All results were compared to the means before and after intervention. Results: After the intervention, the RA, EO, and IO showed increased muscle activation and the ES showed decreased muscle activation. The visual analogue scale decreased after intervention and the K-ODI decreased after intervention. Conclusion: Modified abdominal draw-in maneuvers in daily life combined with therapeutic exercises may be effective in relieving pain and dysfunctions in chronic low back pain patients.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.129-134
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• 1998

The ability for tissue transfer based on microvascular anastomosis has created a revolution in microsurgical free tissue transplantation. The advantages of cutaneous flaps are that they are soft, durable and provide a good cosmetic reconstruction and muscle flaps have a more vigorous blood supply and a longer, larger vascular pedicle than cutaneous flaps. From June 1992 through May 1997, 68 patients had received reconstructive microsurgery in the lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The results were as follows. 1. The age distribution was from 15 years of age to 67 and male were 59 cases and female 9 cases. 2. The most common cause was traffic accident(54 cases, 79.4%) and followed chronic osteomyelitis(9 cases, 13.2%), industrial accident(3 cases, 4.4%), burn(1 case, 1.5%) and farm injury(1 case, 1.5%). 3. Latissimus dorsi myocutaneous flap were 25 cases(36.8%), rectus abdominis muscle flap 21 cases(30.9%), gracilis muscle flap 10 cases(14.7%), dorsalis pedis flap 9 cases(13.2%), groin 2(2.9%) and vascularized iliac osteocutaneous flap 1(1.5%). 4. 61 cases(89.7%) of 68 cases were survived and the exposed vital tissues and bones were covered and revealed good cosmetic results.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.14-17
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• 2011

Autologous breast reconstruction after mastectomy in breast cancer patient is now increasing. The deep inferior epigastric artery (DIEA) free flap is well known as an ideal donor site for the microsurgical breast reconstruction. The branching pattern of the DIEA was well described in the literature. In that study, DIEA has three branching patterns near the arcuate line. We describe a case in which branching variation of the DIEA before entering the posterior surface of the rectus abdominis muscle. In three cases, DIEA originated from the external iliac artery ascended as a double trunk at 1cm, 2cm, and 4cm above the originating point, respectively. In one case, DIEA ascended as a single trunk along the linea alba toward to the umbilicus until it supply overlying subcutaneous tissue. Preoperative 3D computed tomographic angiography to identify the anomaly is recommended and meticulous dissection to the originating point of DIEA is needed.

• The Journal of Korean Physical Therapy
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• v.30 no.1
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• pp.1-7
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• 2018

Objective: This study aimed to determine the efficacy of flexible pole training combined with lumbar stabilization in improving trunk muscle activities and to investigate the difference according to posture in young adults. Methods: Twenty-five participants were enrolled in this study. The subjects were randomly allocated into either the flexible pole group or the rigid pole group. Participants performed lumbar stabilization exercises on quadruped and curl-up, with the flexible pole or rigid pole. Electromyography was used to assess the percent maximal voluntary isometric contracion (%MVIC) of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spine (ES) muscles. All participants completed one 30-minute session per day, 3 days per week, for 6 weeks. The evaluation was performed before and 6 weeks after the training, and follow-up. The data were analyzed using independent t-test and two-way repeated measure analysis of variance to determine the statistical significance. Results: The flexible pole in curl-up showed significant differences in EO and IO muscle activities compared with the rigid pole. The flexible pole in quadruped showed significant differences in IO and ES muscle activities compared with the rigid pole. The RA, EO, IO, and ES muscle activities of both groups were significantly higher after 6 weeks training. Conclusion: The flexible pole in curl-up and quadruped showed an improvement in trunk muscle activation. The flexible pole combined with lumbar stabilization will be useful as an exercise tool to improve activity of trunk muscles.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.3
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• pp.333-338
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• 2014

PURPOSE: The purpose of this study was to investigate any changes in abdominal muscle activity after curl-up and jack-knife exercisse using a sling and swiss-ball. METHODS: Sixteen asymptomatic subjects were randomly assigned into either a sling exercise group (SG) or swiss-ball exercise group (SBG). Subjects performed curl-up and jack-knife exercise using sling and swiss ball. Activity of abdominal muscles (rectus abdominis and external oblique) was assessed using surface electromyography (EMG) and normalized maximal voluntary isometric contraction (MVIC) before and after exercises. The significance of differences between the SG and the SBG was evaluated by analysis of covariance (ANCOVA). RESULTS: There was an increase in activity of all abdominal muscles after the curl-up and jack-knife exercises for 6 weeks. However, there was not a significant difference between the SG and the SBG after curl-up exercise (p>.05). There was also not a significant difference between the SG and the SBG after Jack-knife exercise (p>.05) except for the right external oblique muscle (p<.05). CONCLUSION: Exercises on an unstable surface using a sling and swiss ball are effective ways of abdominal muscle exercise.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.29-32
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• 2009

Purpose: Introduction of the mammary implant through the abdominal route has been well known since late 1960s, but the use of transabdominal route for contralateral breast augmentation in transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction patients has not been reported in Korean literature. The authors report their experience with technical points as well as the selection of the appropriate patients. Methods: Simultaneous contralateral augmentation mammaplasty through transabdominal route was performed in 11 patients who underwent TRAM breast reconstruction from August 2003 to May 2008 with a mean follow up of 27 months. The pocket was created under direct vision: 3 subglandular, 7 subpectoral, and 1 dual plane was dissected. Eight saline and 3 silicone gel implants were used with an average volume of 165 cc. Results: There were no complications such as infection, hematoma, implant displacement, and capsular contracture. The result was well maintained throughout the follow up period. Conclusion: Transabdominal route could be recommended in selected patients for contralateral augmentation in TRAM breast reconstruction.

• Archives of Plastic Surgery
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• v.40 no.3
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• pp.173-180
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• 2013

As microvascular techniques continue to improve, perforator flap free tissue transfer is now the gold standard for autologous breast reconstruction. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM) flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, superior gluteal artery perforator flap, and transverse/vertical upper gracilis flap. In addition, pedicled flaps can be very successful in the right hands and the right patient, such as the pedicled TRAM flap, latissimus dorsi flap, and thoracodorsal artery perforator. Each flap comes with its own advantages and disadvantages related to tissue properties and donor-site morbidity. Currently, the problem is how to determine the most appropriate flap for a particular patient among those potential candidates. Based on a thorough review of the literature and accumulated experiences in the author's institution, this article provides a logical approach to autologous breast reconstruction. The algorithms presented here can be helpful to customize breast reconstruction to individual patient needs.