• Archives of Plastic Surgery
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• v.47 no.2
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• pp.146-152
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• 2020

Background Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. Methods We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. Results Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were "miscellaneous." In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. Conclusions CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

• Journal of the Ergonomics Society of Korea
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• v.30 no.5
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• pp.571-579
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• 2011

Objective: The purpose of this research is to provide exercise programs for the prevention of work related chronic back pain. Background: In order to prevent musculoskeletal disease, including proper medical care health promotion programs are needed. Method: This is a research of musculoskeletal disease looking at 618 workers working at a car engine manufacturing factory from April to July of 2008. Through questionnaire specific areas of musculoskeletal diseases experienced by the workers were identified and preventative exercise program for chronic low back pain was recommended. Result: Research showed that of the musculoskeletal disease experienced by the workers, 197 presented with low back pain, 171 presented with shoulder pain, 64 presented with neck pain and 44 presented with knee pain. The symptoms of low back pain included stiffness(143), twinge and burning sensation(24) and absence of sensation(19). Using this result 4 types of exercise programs were recommended for prevention of chronic low back pain. Conclusion: Preventative exercise programs recommended for the workers in this research is easily accessible for the workers. Use of the suggested exercise programs will inevitably decrease work related low back pain. Also 2 other recommendations were made: 1) Internal structural change may be necessary using ergonomics. 2) More exercise programs to be used to increase adaptation and tolerance of joints and muscles that are constantly used for repetitive work. Application: This study can be used to provide for the prevention of work-related Chronic Low Back pain.

• Physical Therapy Korea
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• v.27 no.1
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• pp.87-92
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• 2020

Background: Bridging exercises are used to enhance the functional stability of the lumbopelvic region in clinical settings. Although most of the studies on bridging exercises have compared the complete activation of the trunk muscles, some recent studies have examined the functional stability of the trunk and the lumbopelvic region and assessed the appropriate recruitment of the local and global muscles during different task levels. Objects: The purpose of this study was to investigate the changes in muscle thickness in the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles during a common bridging exercise on an unstable surface and to determine whether these changes differ based on the surface used. Methods: Twenty-five healthy young adults (8 males, 17 females) were recruited. The subjects were randomly assigned to either the exercise progression with a sling bridge group or the ball bridging exercise progression group, each with three stages of increasing difficulty. Each position was measured three times with an ultrasonic diagnostic imaging system, and the mean values were recorded for analysis. Results: No significant differences were observed between the TrA, IO, or EO muscle thickness ratios between the sling and ball exercise groups (p > 0.05). There were also no significant differences in the EO muscle thickness ratios between the tasks irrespective of whether the sling or ball was used. However, the TrA and IO thickness ratios in both groups were significantly greater during stages 2 and 3 compared to stage 1. Conclusion: The results suggest that the use of slings and balls during bridging exercises is effective in activating the deep abdominal muscles.

• Physical Therapy Rehabilitation Science
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• v.9 no.1
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• pp.49-54
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• 2020

Objective: The purposes of this study was to evaluate the diagnostic values of abdominal muscles thickness and sterno-costal angle as the quantitative diagnostic indicators for young adults with rounded shoulders. Design: A observational, cross-sectional study. Methods: This study included thirty-three male participants in order to examine the relationship among thoracic kyphosis, sternocostal angle, and abdominal muscle thickness. We used ultrasound imaging to measure the muscle thickness, two gravity-dependent inclinometers to measure the kyphosis angle, and Image J to measure the sterno-costal angle. Results: There was a significant positive correlation between the amount of thoracic kyphosis angle and muscle thickness of the external oblique (EO) on the right side (r=0.931), and on the left side (r=0.432), and the transverse abdominis (TrA) (r=0.649). There was also a significant negative correlation between the thoracic kyphosis angle and the sterno-costal angle at the right side (r=-0.942) and at the left side (r=-0.860). There was a significant positive relationship with muscle thickness of the EO and TrA on the right side with the thoracic kyphosis angle, and was significant negative relationship with the sterno-costal angle on both sides. Conclusions: The results of the study suggest that the thoracic kyphosis angle is related to muscle thickness of the EO and TrA on the dominant side and the sterno-costal angle. We also suggest that future studies are needed to determine how strengthening the abdominal muscles may contribute to preventing excessive thoracic kyphosis in young adults.

• Journal of the Korean Institute of Intelligent Systems
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• v.22 no.3
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• pp.341-346
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• 2012

In rehabilitation where ultrasonographic diagnosis is not popular, it could be subjective by medical expert's experience. Thus, it is necessary to develop an objective automative procedure in ultrasonic image analysis. A disadvantage of existing automative analytic procedure in musculoskeletal system is to designate an incorrect muscle area when the figure of fascia is vague. In this study, we propose a new procedure to extract more accurate muscle area in abdomen ultrasonic image for that purpose. After removing unnecessary noise from input image, we apply End-in Search algorithm to enhance the contrast between fascia and muscle area. Then after extracting initial muscle area by Up-Down search, we trace the fascia area with a mask based on morphological and directional information. By this tracing of mask movements, we can emphasize the fascia area to extract more accurate muscle area in result. This new procedure is proven to be more effective than existing methods in experiment using convex ultrasound images that are used in real world rehabilitation diagnosis.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.261-264
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• 2007

Purpose: Extranodal marginal zone B cell lymphoma of MALT type represents approximately 8% of non-Hodgkin's lymphomas and this lymphoma is present in extranodal sites. Although the presentation of this lymphomain in stomach is usually associated with H. pylori infection in 95% of cases, MALT lymphoma found in soft tissue has been reported very rarely in the field of plastic surgery. We report a case of MALT lymphoma in the submandibular gland without any involvement of other organs such as the stomach. Methods: A 49-year-old man complained of a huge neck mass sized about $10{\times}12cm$. It started about 2 years ago and grew rapidly for the late 6 months. It was of hard nature with erythematous skin overlying it. Under the diagnosis of possible malignant lymphoma or sarcoma, radical resection was performed and the defect was reconstructed using transverse rectus abdominis musculocutaneous free flap. Results: The mass was well demarcated from the normal tissue, $11{\times}10.5{\times}10cm$ in size and whitish-gray color. Immunohistochemical analysis demonstrated that the tumor cells were LCA(+), CD20(+), CD3(-) and CD5(-). The tumor was diagnosed as extranodal marginal zone B cell lymphoma. The patient was treated with prophylactic radiation therapy after surgery, there was no complication for 1 year. Conclusion: We reported that very rare form of MALT lymphoma in 49-year-old male patient was experienced with clinical characteristics, histologic features and references.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.715-717
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• 2011

Purpose: In cases of breast reconstruction with a free transverse rectus abdominis musculocutaneous (TRAM) flap after skin-sparing mastectomy with nipple-areolar complex (NAC) removal, the flat contour of the flap's skin paddle can easily look unnatural and dissatisfying. Reconstructed NAC on the flap surface lacks the elevated contour that the normal areola possesses, resulting in an unnatural final result. Therefore, we would like to introduce a novel method to improve this problem and report the satisfactory results we obtained. Methods: Operations were conducted on 19 patients who underwent immediate breast reconstruction with a free TRAM flap and skin-sparing mastectomy from January 2009 to January 2010, with a mean follow-up of nine months. While the TRAM free flap was being inset, a purse-string suture was carried out on the dermal layer of skin flap to create a slight protrusion with Gore-$Tex^{(R)}$ sutures. Results: The elevated mound surrounding the NAC was well maintained for an average follow-up period of nine months. Nipple projection was also well maintained. There was no complaint about breast contour or nipple height reduction. In addition, there was no reported incidence of other complications. Conclusion: The purse-string suture technique presents a more natural breast silhouette around the NAC and helps to maintain nipple projection. Furthermore, it does not require any supplementary incisions or complicated skills. There has been no report of additional complications using this technique.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.401-407
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• 2011

Purpose: A number of flap for nipple reconstruction have been well described in the literature. However, most of these techniques do not permit the reconstruction of a projecting nipple and all are hampered to some extent by long-term loss of nipple projection. The objective of this study is to evaluate the long-term result and clinical efficacy of nipple reconstruction using skate flap technique after breast reconstruction. Methods: A retrospective chart review was carried out on 23 patients who underwent 25 nipple reconstructions. In those patients with greater than 10 mm nipple projection, reconstruction with skate flap and full-thickness skin graft and/or tattooing was performed. Maintenance of nipple projection was then carefully assessed over one-year follow-up. The following factors were analyzed: type of breast reconstruction, type of areola reconstruction, followup period, decrease in nipple projection, complication, and whether secondary nipple reconstruction was necessary and/or performed. Results: Breast reconstructions were performed in 17 patients with free transverse rectus abdominis musculocutaneous flap, 3 patients with extended latissimus dorsi musculocutaneous flap, and 3 patients with expander and implant. The mean follow-up after nipple reconstruction was 17 months. Mean loss of projection were $17.0{\pm}13.99%$, $25.0{\pm}12.70%$, $30.0{\pm}12.57%$ and $30.8{\pm}12.49%$ at 3, 6, 9 months and over one year, respectively. The greatest decrease in projection was noted in the first 3 months following surgery. Conclusion: These results indicated that nipple reconstruction with skate flap showed about 70 percent of the projection achieved over one year postoperation. Therefore, the skate flap may be a reliable method of nipple reconstruction in those patients with greater than 10 mm nipple projection.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.555-558
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• 2009

Purpose: The high success rate of free flap transfers is well documented in previous literature, and is possible due to the early detection of vascular compromise and timely reoperation. We specifically analyzed the operative results of immediate and delayed reconstruction with free transverse rectus abdominis musculocutaneous(TRAM) flap respectively in order to reveal its distinctive features on timing and causes of vascular compromise. Methods: The senior author operated on 158 patients, 161 cases of free TRAM flap for breast reconstruction. 51 patients underwent delayed reconstruction, whilst immediate reconstruction was performed in the other 107 patients. All patients were monitored every 3 hours for the first 3 days. We reviewed medical records of all patients, and tested statistical significance with the Fisher's test. Results: Reoperation was performed in 20 cases, but the cases include hematoma with bleeding focus and arterial anastomosis site rupture due to abrupt arm abduction. We performed reoperation in 15 cases of suspicious vascular compromise. Flap compromise was noticed mostly within 24 hours, but not longer than 72 hours. Venous compromise was dominant by 11 cases (73.3%). There was difference in the timing of flap compromise between immediate and delayed reconstruction. All the cases of delayed reconstruction did not show signs of vascular compromise after 12 hours postoperatively. On the other hand, cases of vascular compromise were observed until 72 hours postoperatively in cases of immediate reconstruction. Conclusion: Delayed reconstruction showed vascular compromise within 12 hours postoperatively, while immediate reconstruction showed compromised until the 3rd postoperative day. If more aggressive monitoring is maintained during this period, we believe salvage of flaps may be increased with more efficiency.

• Physical Therapy Rehabilitation Science
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• v.3 no.2
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• pp.93-100
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• 2014

Objective: The purpose of this study was to determine the effect of the abdominal bracing (AB) and abdominal bracing combined with ankle dorsiflexion (ABDF) on abdominal muscle thickness and strength in patients with chronic low back pain (LBP). Design: Two group pretest posttest design. Methods: Sixteen subjects were divided randomly into two group: ABDF group (n=8), and alone AB group (n=8). The ABDF group practiced AB exercise with additional ankle dorsiflexion. AB group practiced only AB exercises. Subjects in both groups received ABDF exercise and AB exercise for 40 min per day, three days per week during a period of three weeks, respectively. All the subjects were evaluated for abdominal muscle thickness and strength before and after intervention using ultrasonography and MedX machine. Results: The external oblique (EO), internal oblique, transverse abdominis (TrA) muscle thickness and the strength produced at $48^{\circ}$, $60^{\circ}$, $72^{\circ}$ showed a significant increase in the ABDF group after intervention, with a more significant improvement in EO and TrA muscle thickness in the ABDF group compared with the AB group (p<0.05). Also, the strength at $48^{\circ}$ strength showed a significant improvement in the ABDF group than the AB group (p<0.05). Conclusions: The study results showed that abdominal muscle contraction exercises with AD in patients with LBP had an influence on abdominal muscle thickness and strength. Therefore, these findings suggest that ABDF may be useful approach for enhancement of abdominal muscle thickness and strength in patients with chronic low back pain.