• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.105-110
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• 2001

Breast reconstruction is an aesthetically critical procedure and should be peformed to match the opposite breast in shape, contour, and position. Many methods were introduced to reconstruct the breast with autogenous tissue. But, free tissue transfer for breast reconstruction has become common method. The transverse rectus abdominis myocutaneous flap technique has been a widely accepted method of breast reconstruction after mastectomy, since the first introduction of free abdominoplasty flap in 1979. In breast reconstruction with a free flap the selection of suitable recipient vessels remains one of the most critical decision for surgeon. The most common recipient site for free flap breast reconstruction is the axillar system. But, the use of the axillary system as a recipient site limits flap movement and flexibility in breast shaping. The use of internal mammary vessels as a recipient site be able to achieve ideal breast symmetry, but that technique require the rib resection. The selection of suitable recipient vessels is most important for successful free tissue transfer. We have performed breast reconstruction with TRAM flaps anastomozed to the internal mammary vessel perforator. We came to the conclusion that this vessel perforator is useful as a recipient site in cases of immediate breast reconstruction with free TRAM flap.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.607-612
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• 2010

Purpose: Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. Methods: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification. 1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps.2 Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation. Results: The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap. Conclusion: The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.277-280
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• 2010

Purpose: The resection of locally advanced or recurred breast cancers frequently result in large chest wall defects and it leads to a great challenges to cover. Generally simple skin grafts are not a practical option for patients because of their poor cosmetic appearance and prognosis. The latissimus dorsi and rectus abdominis musculocutaneous flap have traditionally been recommended for closure of these large defects. Though the cosmetic result of reconstruction using these flaps is often excellent, but has significant drawbacks. Therefore, we thought that chest wall reconstruction using the external oblique musculocutaneous flap can be an alternative method for extensive chest wall defect related to large, locally advanced breast carcinoma. Methods & Results: We present a case of a 50-year-old Korean female, refered to our department with a left breast tumor for 10 months. CT demonstrate a large tumor on the left anterior chest wall and multiple nodules of varying size in the cervical areas and liver. FDG-PET showed areas of hot uptake throughout the left chest wall, mediastinum and liver. Biopsy was consistent with invasive ductal carcinoma (Grade III). The initial tumor was considered inoperable, so a series of chemotherapy was initiated. Though the size of the breast mass was slightly decreased, the patient continued to suffer from purulent discharge, unpleasant odor and contact bleeding of the mass, the salvage mastectomy was performed. Conclusion: We could reconstruct $23{\times}16\;cm$ sized large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique musculocutaneous flap successfully. Immediate postoperatively checked flap was healthy. Overall result was good without any significant complications and discharged 3 weeks after operation.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.702-708
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• 2014

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery. Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level. Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (${\pm}12.87$) mm, and -8.14 (${\pm}15.24$) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (${\pm}0.39$) mm and 1.37 (${\pm}0.33$) mm, and they were found at a mean depth of 9.75 (${\pm}2.67$) mm and 8.33 (${\pm}2.65$) mm, respectively. Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.1
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• pp.125-132
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• 2014

PURPOSE: This study aims to determine the optimal knee joint angle and hip joint angle for minimizing the cervical muscle tension and maximizing the muscle activity of the trunk during the bridging exercise for trunk stabilization. METHODS: The bridging exercise in this study included seven forms of exercise: having a knee joint flexion angle of $120^{\circ}$, $90^{\circ}$, $60^{\circ}$, $45^{\circ}$ and hip joint abduction angle of $15^{\circ}$, $10^{\circ}$, $5^{\circ}$. The posture of the bridging exercise was as follows. To prevent the increase of hyper lumbar lordosis during the bridging exercise, the exercise was practiced after maintaining the lumbar neutral position through the pelvic posterior tilting exercise. RESULTS: The abduction angles did not result in statistically significant effects on the cervical erector, external oblique, rectus abdominis and erector spinae muscles. However, in relation to the knee joint angles, during the bridging exercise, statistically significant results were exhibited. CONCLUSION: The knee joint angle affected the muscle activity of the neck muscle. The greater the knee joint angle, the lower the load placed on the neck muscle. In contrast, the load increased as the knee joint angle decreased. In addition, the muscle activity of the neck muscle and trunk muscle increased as the knee joint angle decreased.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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• pp.53-62
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• 2016

PURPOSE: The purpose of this study was to investigate the effects of a supplementary Ki-hap technique and verbal encouragement on the activation of abdominal muscles during performance of crunch exercise in healthy subjects. METHODS: 93 subjects were randomly allocated to three group, crunch exercise group (CG), crunch exercise with Ki-hap group (CKG), and crunch exercise with Ki-hap and verbal encouragement group (CKVG), with 31 subjects in each group, respectively. The interventions were conducted over three trials in each group, and measurements were performed on each subject by one examiner in three trials. The activation of rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles were evaluated using electromyography (EMG) during performance of crunch exercise with non-Ki-hap, Ki-hap and Ki-hap combined with verbal encouragement. RESULTS: Our results showed a significantly greater increase in the EMG patterns of all muscles during performance of crunch exercise in the CKG (p<0.05) compared to the CG and CKVG. The results also showed that there were significantly greater increase in the activation of EO and IO muscles in those of the CKVG (p<0.05) compared with the CG. CONCLUSION: These findings demonstrated that addition of the Ki-hap technique and verbal encouragement during performance of crunch exercise, at the same time, would suggest positive evidence for improving activation of abdominal muscles.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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• pp.25-31
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• 2016

PURPOSE: The purpose of this study was to compare the trunk muscle activity according to the direction of upper extremity lifting using elastic band. METHODS: Thirty three healthy individuals participated in this study. Each subject performed upper extremity lifting using elastic band on two different directions (straight and diagonal). And then we compared the muscle activity of respective trunk muscles of both directions. In order to examine the muscle activity of trunk muscle, we used the electromyogram to measure peak and mean torque in shoulder 90 degree flexion with sitting position. Electromyographic activities were recorded from the external oblique, internal oblique, rectus abdominis, and erector spine muscles during upper extremity lifting. RESULTS: As a result, first, there was significant difference between two directions. The muscle activity of ipsilateral external oblique and contralateral internal oblique is significantly increased in both straight and diagonal directions (p<0.05). Second, the muscle activities of external oblique and internal oblique of both side showed significant difference in diagonal direction (p<0.05). Third, the muscle activity of erector spine of both side showed significant difference in straight direction (p<0.05). CONCLUSION: Through this study, it is important that implement diagonal direction exercise at sitting positions to help increasing muscle activity of ipsilateral external oblique and contralateral internal oblique on patients when activating the trunk muscle or stabilizing the trunk.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.1
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• pp.77-84
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• 2020

PURPOSE: This study compared the activities of the trunk muscles during crutch walking to determine which of the crutch length measurements is most beneficial. METHODS: Twenty young women volunteered to participate in this study. After adjusting crutch length, the participants performed a three-point walking with nondominant leg limited in weight bearing. This study used six crutch length measurements: (1) Height-40.6cm, (2) Height'.77, (3) Olecranon-to-finger length, (4) Axillary-toheel length, (5) Arm-span length-40.6cm, and (6) Arm-span length'.77. The EMG activities of the internal oblique (IO), rectus abdominis (RA), multifidus (MF), and erector spinae (ES), muscles on the weight bearing side were monitored using wireless surface EMG. RESULTS: The EMG activities of the RA and ES appeared to be significantly different among the crutch length measurements (p<.05). The post-hoc test showed that the 'Arm-span length-40.6cm' was significantly greater in the RA activity when compared to the 'Height'.77' and 'Axillary-to-heel length' measurements, and in the ES activity when compared to 'Height'.77' measurements. Furthermore, IO/RA and MF/ES ratios showed significant differences among the crutch length measurements (p<.05). In the post-hoc test, significant difference was observed between 'Olecranon-to-finger length' and 'Arm-span length-40.6cm' for the IO/RA ratio, and between 'Height'.77' and 'Olecranon-to-finger length' and between 'Height'.77' and 'Arm-span length-40.6cm' measurement for the MF/ES ratio. CONCLUSION: These findings suggest that the 'Height'.77' measurement is relatively advantageous to optimize the activities of trunk muscles during the crutch walking, and allow simple measurements of the crutch length.

• The Journal of Korean Physical Therapy
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• v.17 no.4
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• pp.601-612
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• 2005

본 연구는 복직근의 기능적 전기자극이 경직형 뇌성마비 아동의 1회 호흡용적과 폐활량 등의 호흡능력과 복직근의 근육활동에 미치는 영향을 알아보기 위해서 대구 시내 OO특수학교에 재학 중인 14세 이상 16세 미만의 경직형 사지 뇌성마비 아동 6명(남자 3, 여자 3)을 대상으로 하여 복직근에 1회 20분. 주 3회씩 총 6주간 기능적 전기자극을 적용하였다. 기능적 전기자극의 적용 6주 전과, 직전에 두 번의 사전 검사와 적용 후 사후 검사를 실시하였다. MP30(Biopack, USA)을 이용하여 폐활량과 예측치 폐활량 백분율, 1회 호흡용적을 검사하였으며 Table면전극 근전도(Noraxon, USA)를 이용하여 복직근의 근육 활동량을 측정하였다. 분석결과는 다음과 같다. 1. 복직근의 기능적 전기자극 적용 6주 전과 직전의 폐활량은 유의한 차이가 없었으나, 적용 후의 폐활량은 적용 전에 비해 유의한 증가를 나타내었다(p<0.05). 2. 복직근의 기능적 전기자극 적용 6주 전과 직전의 예측치 폐활량 백분율은 유의한 차이가 없었으나, 적용 후의 예측치 폐활량 백분율은 적용 전에 비해 유의한 증가를 나타내었다(p<0.05). 3. 복직근의 기능적 전기자극 적용 6주 전과 직전의 1회 호흡용적은 유의한 차이가 없었으나, 적용 후의 1회 호흡용적은 적용 전에 비해 유의한 증가를 나타내었다(p<0.05). 4. 복직근의 기능적 전기자극 적용 6주 전과 직전의 복직근의 활동 값은 유의한 차이가 없었으나 적용 후의 복직근의 활동 값은 적용 전에 비해 유의한 증가를 나타내었다(p<0.05). 이상의 결과를 종합해 볼 때 6주간의 복직근의 기능적 전기자극이 경직형 뇌성마비 아동에 있어서 복직근의 근력을 강화시킴으로써 폐활량과 1회 호흡 용적 등의 호흡능력을 향상시킴을 확인할 수 있었다.

• Archives of Plastic Surgery
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• v.45 no.5
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• pp.441-448
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• 2018

Background Previously, surveys have been used to investigate breast reconstruction statistics. Since 2015, breast reconstruction surgery after mastectomy has been covered by the National Health Insurance Service in Korea, and data from breast reconstruction patients are now available from the Health Insurance Review and Assessment Service (HIRA). We investigated statistics in breast reconstruction in Korea through statistics provided by the HIRA Big Data Hub. Methods We investigated the number of cases in mastectomy and breast reconstruction methods from April 1, 2015 to December 31, 2016. Data were furnished by the HIRA Big Data Hub and accessed remotely online. Results were tabulated using SAS Enterprise version 6.1. Results The 31,155 mastectomy cases included 7,088 breast reconstruction cases. Implant-based methods were used in 4,702 cases, and autologous methods in 2,386. The implant-based reconstructions included 1,896 direct-to-implant and 2,806 tissue-expander (2-stage) breast reconstructions. The 2-stage tissue-expander reconstructions included 1,624 expander insertions (first stage) and 1,182 expander-to-permanent-implant exchanges (second stage). Of the autologous breast reconstructions, 705 involved latissimus dorsi muscle flaps, 498 involved pedicled transverse rectus abdominis myocutaneous (TRAM) flaps, and 1,183 involved free-tissue transfer TRAM flaps, including deep inferior epigastric perforator free-tissue transfer flaps. There were 1,707 nipple-areolar complex reconstructions, including 1,565 nipple reconstructions and 142 areola reconstructions. The 1-year mean number of breast reconstructions was 4,050. Conclusions This was the first attempt to evaluate the total number of breast reconstruction procedures using accurate, comprehensive data, and our findings may prove valuable as a foundation for future statistical studies of breast reconstruction procedures in Korea.