• Journal of Yeungnam Medical Science
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• 제28권2호
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• pp.116-123
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• 2011

The incidence of breast cancer, the second most prevalent cancer type in South Korea, has increased by 6.8% annually in the last six years. The higher number of breast cancer patients has led to an increase in the cases of skin-sparing mastectomies, thereby increasing the need for reconstructive procedures. The reconstruction options include alloplastic techniques such as implant or autologous reconstruction with numerous flaps. The abdominal area is the preferred donor site for the harvest of autologous tissue for breast reconstruction. Breast reconstruction using abdonimal tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing TRAM, DIEP, and SIEA flap techniques were later developed in an effort to decrease the abdominal-donar-site morbidity by decreasing the injury to the rectus abdominis muscle and fascia. This article summarizes the various abdominal flaps for breast reconstruction.

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.141-145
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• 2002

Rectus abdominis muscle free flap is widely used for breast reconstruction and soft tissue defect in lower leg but donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. Recently, to minimize donor-site morbidity, there has been a surge in interest in deep inferior epigastric perforator(DIEP) free flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. Between August of 1995 and September of 2002, topographic investigation of DIEP was performed during the elevation of 97 cases of TRAM free flap and 5 cases of DIEP free flap. There were 84 cases of breast reconstructions, 12 cases of lower leg reconstructions, and 6 cases of head and neck reconstruction. We could observe total 10 to 12 perforators on each rectus abdominis muscle below umbilicus. Among these, the numbers of large perforators(>1.5mm of diameter) were mean 2.1 in lateral half of rectus abdominis muscle, mean 1.2 in medial half, and mean 0.5 in linea alba and paramedian. DIEP free flap provides ample amount of well vascularized soft tissue without inclusion of any rectus abdominis muscle and fascia and minimizes donor-site morbidity. One perforator with significant flow can perfuse the whole flap. For large flap, a perforator of the medial row provides better perfusion to zone-4 than one of lateral row and, if diameter of perforator is small, $2{\sim}3$ perforators can be used. According to the condition of recipient-site, thin flap can be harvested. As DIEP free flap has many advantage, perforator topography will be useful in increasing clinical usage of DIEP free flap.

• PNF and Movement
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• 제17권1호
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• pp.137-144
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• 2019

Purpose: This study examined the effects of the abdominal drawing-in maneuver (ADIM) on muscle activity in the trunk and legs while subjects walk on a ramp. Methods: The subjects were healthy adult males (n=15) and females (n=8) in their twenties. The subjects were asked to maintain the ADIM contraction for 15 minutes using a pressure biofeedback unit. Their muscle activity was then measured while ascending or descending the ramp with or without the ADIM contraction maintained. Activity in the sternocleidomastoid, splenius capitis, rectus abdominis, external oblique abdominal, transversus abdominis, erector spinae, vastus medialis, and vastus lateralis muscles was measured using surface electromyography (TM DTS, Noraxon, USA). A paired t-test was conducted using SPSS 18.0 (IBM) for statistical data processing. Results: Maintaining the ADIM contraction during ascension led to a significant increase (p<0.05) in muscle activity for the rectus abdominis, transversus abdominis, vastus medialis, and vastus lateralis, but a significant decrease (p<0.05) in muscle activity for the erector spinae, when compared to the same activity without the ADIM maintained. Furthermore, maintaining the ADIM contraction during descent led to a significant increase (p<0.05) in muscle activity for the rectus abdominis, external abdominal oblique, transversus abdominis, vastus medialis, and vastus lateralis, but a significant decrease (p<0.05) in muscle activity for the erector spinae, when compared to the same activity without the ADIM maintained. Conclusion: As a result of this study, it maintains the ADIM and reduces lumbar muscle activity at the waist and increases muscle activity in the legs when walking on a ramp. Therefore, maintaining the ADIM contraction during ramp walking is recommended as training to improve the function of patients' muscular skeleton.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.480-482
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• 2008

Purpose: Unexpected vascular anomaly can make the surgeon embarrassing and even affects on the operative results of free flap reconstruction. We experienced one case of abnormal course of deep inferior epigastric vessels during the elevation of rectus abdominis musculocutaneous free flap for breast reconstruction. Methods: A 38-year-old female patient who had modified radical mastectomy on her left breast underwent delayed breast reconstruction with rectus abdominis musculocutaneous free flap. Results: Flap elevation was performed in the traditional manner. During the flap elevation, it was detected that the deep inferior epigastric vessels ran between the rectus abdominis muscle and anterior rectus sheath along the midline after traversing the rectus muscle. The reconstructive surgery was successful and there were no postoperative complications. Conclusion: This is the first case reported in Korea. We should always know about the possibilities of unexpected anomaly that we can encounter.

• 한국운동역학회지
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• 제21권1호
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• pp.57-65
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• 2011

This research was conducted to biomechanically analyze Tippelt motion in parallel bars, and establish technical understanding. To achieve that goal, the performances of the Tippelt acts carried out by five world top-class national gymnasts in the parallel bars 3-dimensional cinematographic analysis and EMG analysis were conducted and following conclusion were obtained. The Tippelt motions of excellent national gymnasts perform tap motion through the down swing of a large circular movements, and perform kick-out motion rapidly extending shoulder joint angle and hip joint angle with the trunk in a position close to perpendicular position at the vertical downwardness of the grasping the bars. At this time, if handstand starting the movement is too delayed or rapidly down swung, it was shown that from the initial falling, unnecessary muscular power was wasted in trapezius, anterior deltoid, erector spinae, latissimus dorsi, upper rectus abdominis, lower rectus abdominis. The muscular parts in tap motion generating muscle action potential were pectoralis major, rectus femoris, upper rectus abdominis, lower rectus abdominis, and those in kick-out motion were upper rectus abdominis, lower rectus abdominis, trapezius and anterior deltoid.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.29-36
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• 2010

The purpose of this study was to present the clinical significance of rectus abdominis free muscle flap for large sized diabetic ulcer and necrosis of the foot to salvage limb. From June 2000 to February 2006, eleven patients were included in our study. There were seven males and four females with a mean age of 58.3 years (48~65) at the surgery. All had a history of diabetics and subsequent huge soft tissue defect caused by necrotizing abscess formation around the foot and the ankle. After complete debridement of large sized, infected necrotic tissue, susceptible intravenous antibiotics and wound care were done. After control of infection, confirmed by clinical and laboratory findings, the rectus abdominis free muscle flap was applied to cover remained large soft tissue defect and to prevent the recurrence of infection. All flaps survived and it provided satisfactory coverage for the soft tissue defect on the foot and the ankle area for a mean of 41.1 months (24~85) follow up period. All except of one patients did not have any recurrence of infection on the operation site and could salvage their limbs. The rectus abdominis free muscle flap could be recommended for large sized soft tissue defect after necrotizing abscess in diabetic foot to salvage major limb.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.68-73
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• 2004

Transverse rectus abdominis muscle (TRAM) free flap is widely used for breast reconstruction, however donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. For the purpose of minimizing donor-site morbidity, there has been a surge in interests in muscle sparing free TRAM flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. The purpose of this study is to investigate complication and morbidity after muscle sparing free TRAM flap. Between August, 1995 and May, 2003, there were 108 cases of muscle sparing free TRAM flap of breast reconstruction. There was no abdominal hernia. There were 4 cases of dog ear, 3 cases of marginal necrosis of apron flap, 2 cases of asymmetry of umbilicus. At 1 year after operation, most patients feel comfortness in physical exercise. Muscle sparing free TRAM flap provides ample amount of well vascularized soft tissue with small inclusion of rectus abdominis muscle and fascia. Also it minimizes donor-site morbidity with rapid recovery of abdominal strength.

• 한국운동역학회지
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• 제33권4호
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• pp.155-163
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• 2023

Objective: The purpose of this study is to identify the difference in the quality of muscle contraction and kick movements according to the presence or absence of back pain in body kick movements of mixed martial arts athletes. Method: In this study, four athletes (32.75 ± 4.79 yrs, 172.50 ± 5.20 cm, 77.73 ± 13.28 kg) who have suffered chronic back pain for more than three months and scored 12 points in the Korean version of ODI. Four painless athletes (33.50 ± 4.04 yrs, 174.25 ± 3.10 cm, 83.50 ± 10.21 kg) participated. Results: During the body kick operation, the pain group had significantly higher muscle activity in the right Transversus abdominis and right Rectus femoris compared to the normal group (p<.05). In the rectus abdominis, the muscle activity was significantly lower than that of the normal group (p<.05). Also, the pain group has a higher toe speed than the normal group Significantly slow (p<.05), there was a delay in contraction of the Transversus abdominis. Conclusion: The results of this study suggest that chronic pain in the lumbar spine degrades the core's function, resulting in inefficient coordination such as Transversus abdominis contraction delay and Transversus abdominis and Rectus femoris excessive activation to compensate for it.

• 한국전문물리치료학회지
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• 제9권3호
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• pp.23-37
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• 2002

This study examined the muscle recruitment order during extension of the hip joint in normal subjects, and evaluated whether the external support obtained from wearing a lumbosacral corset had an effect on muscle recruitment leading to increased lumbar stability. The subjects were 40 normal adults (32 male, 8 female) with no history of low back pain and no pathological findings in the nervous or musculoskeletal systems. All subjects extended their hip joints under 3 positions (prone, sidelying, standing). During extension, the onsets of contraction of the rectus abdominis, gluteus maximus, and semitendinosus muscles were measured. Electromyographic activity was measured using a surface electrode, and the muscle contraction onset time was designated as the point exceeding a threshold of 25 ms, using a mean plus twice of the standard deviation. To compare the average order of muscle contraction onset time, a Freedman two-way analysis of variance by ranks was used. The relative difference between muscle contraction onset time wearing and not wearing a lumbosacral corset was measured using a paired t-test. A difference in the average muscle contraction onset order for the rectus abdominis, gluteus maximus, and semitendinosus muscles was observed (p<.05) among three positions. However, wearing a lumbosacral corset did not. change the contraction order. In addition, wearing a lumbosacral corset produced a significant difference (p<.05) in the relative onset time between the rectus abdominis and gluteus maximus in the standing position, but no difference was observed for the other muscles or positions. In the future, patients suffering from low back pain should be compared with normal subjects to determine the effectiveness of a lumbosacral corset in changing muscle recruitment order.

• 대한통합의학회지
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• 제6권4호
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• pp.91-100
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• 2018

Purpose : The study investigated the effects of Pilates exercise on strengthening trunk muscles of females who perform such exercise for the purpose of comparing activation of trunk muscles that contact while performing Pilates motions between females with or without at least 8 weeks of Pilates experience. Methods : The study investigated 10 females with at least 8 weeks of Pilates experience in the past 6 months (experienced group) and 10 healthy females without Pilates experience (non-experienced group). The study used basic Pilates postures involving hip abduction, lift, and leg swing motions as the measurement postures in comparing the activation of muscles used for stabilization, such as the rectus abdominis, external oblique abdominal, and transverse abdominis & internal oblique abdominal muscles. Surface electromyography was used for measuring muscle activation, and the measurements targeted activation of the rectus abdominis, external oblique abdominal, transversus abdominis, and internal oblique abdominal muscles. Results : The study results showed that, as compared to the non-experienced group, the experienced group had significantly higher muscle activation in the transverse abdominis and internal oblique abdominal muscles during hip abduction (p<.05) and significantly higher muscle activation in the rectus abdominis, external oblique abdominal, and transverse abdominis & internal oblique abdominal muscles during lift and leg swing motions (p<.05). Conclusion : Pilates exercise performed over a long period can be recommended as an effective exercise method that can increase the activation of trunk muscle, and especially, repeated performance of highly difficult motions can increase muscle activation even more, which can help promote spinal stabilization, prevent pain, and improve performance of activities of daily living.