• Archives of Plastic Surgery
• /
• 제33권3호
• /
• pp.298-302
• /
• 2006

Various method of insetting the transverse rectus abdominis myocutaneous flap for breast reconstruction has been reported in literature. The Bostwick's principle is commonly applied, which utilizes contralateral pedicle in a vertical or oblique flap inset position and ipsilateral pedicle in the transverse position. But it is relatively a complex and difficult technique, thus requires a more simplified strategy. We have formulated a new insetting method, in which the contralateral pedicled TRAM flap with an oblique($0^{\circ}-90^{\circ}$) flap inset was carried out. We used this method in 100 cases from July 2001 to June 2003. This maneuver places Hartrampf's zones I and III with good vascularity in the medial side, and zone II in lateral side of breast. Fat necrosis was observed in 14 patients(14%) and of these, only three cases needed surgical excision. This simplified method is easy to learn. Specifically, fat necrosis removal is easy with more tolerable aesthetic results, especially in Asian patients with smaller breasts.

• The Journal of Korean Physical Therapy
• /
• 제27권4호
• /
• pp.270-274
• /
• 2015

Purpose: The purpose of this study was to examine the electromyographic (EMG) activity of the abdominal muscles and to compare the activity ratios of the bilateral rectus abdominis (RA) to oblique abdominal muscles during shoulder abduction in opposite directions with single leg raising (SLR) performed in the supine position on a foam roller. Methods: Fifteen healthy subjects were recruited to the study. Each subject lay on the foam roller and performed left single leg raising with right or left shoulder $90^{\circ}$ abduction (Abd); performed in a random order. Surface EMG recordings of selected abdominal muscles (i.e., the RA, external oblique abdominis [EO], internal oblique abdominis [IO], and transverse abdominis [TrA]) were normalized to maximum voluntary isometric contraction. EO/RA and IO and TrA/RA ratios were determined with surface EMG. Data were analyzed by Independent t-test. The statistical significance level was p<0.05. Results: The results were as follows: (1) the right RA, left EO, and right IO and TrA muscle activities increased significantly at the left SLR with left Abd compared to the left SLR with right Abd (p<0.05); and (2) the ratio of right EO/RA activity increased significantly at the left SLR with right Abd compared to left Abd (p<0.05). Conclusion: These findings suggest that left SLR with left Abd on a foam roller is an appropriate exercise for activation of specific oblique abdominal muscles.

• Archives of Reconstructive Microsurgery
• /
• 제10권1호
• /
• pp.28-33
• /
• 2001

The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

• Archives of Plastic Surgery
• /
• 제38권6호
• /
• pp.803-807
• /
• 2011

Purpose: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. Methods: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. Results: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft (8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients (8.50). Conclusion: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.

• Physical Therapy Rehabilitation Science
• /
• 제11권2호
• /
• pp.136-144
• /
• 2022

Objective: This study was to identify the effect of pressure biofeedback applied in various postures that allow the application of abdominal drawing-in. Design: A cross sectional study. Methods: The study intended to compare changes in the thickness of abdominal muscles between different postures when abdominal drawing-in was performed using a pressure biofeedback unit in five postures and to compare differences in terms of measures such as the transverse abdominis's preferential activation ratio(PAR). Data measured from 30 healthy individuals were used for data analysis. A paired t-test and repeated measures analysis of variance was performed to compare the thickness of each abdominal muscle. Results: The transverse abdominis's and internal oblique's thickness showed statistically significant differences in all postures when abdominal drawing-in (p<0.05). In the comparison between the postures, statistically significant differences were observed between the positions of hook-lying and wall support standing and between supine and wall support standing and between hook-lying and sitting (p<0.05). In terms of the transverse abdominis's PAR in each posture, statistically significant differences were observed between hook-lying and quadruped, hook-lying and sitting, hook-lying and wall support standing, quadruped and supine, sitting and supine, as well as wall support standing and supine (p<0.05). Conclusions: When abdominal drawing-in using pressure biofeedback unit is performed for stabilization exercises, selecting and applying specific postures according to targeted muscles and the subject's functional ability will help provide a more efficient and accurate intervention.

• PNF and Movement
• /
• 제21권2호
• /
• pp.243-253
• /
• 2023

Purpose: This study aimed to investigate the effects of an abdominal drawing-in maneuver (ADIM) with a light load while sitting on transverse abdominis contraction in subjects with and without low back pain. Methods: In this study, 20 participants with chronic low back pain and 20 controls participated. Ultrasonography was used to assess the thickness of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) muscles. Muscle thickness was measured at rest and during ADIM in three different sitting postures: (1) just sitting, (2) sitting loaded position (holding a 1 or 2 kg dumbbell in each hand), and (3) sitting loaded shoulder flexion position (holding a 1 or 2 kg dumbbell in each hand). Results: The contraction ratio (CR) and preferential activation ratio (PAR) of the TrA during ADIM had no significant interactional effect between the group and the sitting postures. However, the CR and PRA of the TrA during the ADIM showed significant differences among the three different sitting postures. The CR of the TrA during the ADIM in the sitting loaded shoulder flexion position was significantly increased compared to that in the sitting position (p<0.05). Moreover, the PRA of the TrA muscle during ADIM in sitting loaded and sitting loaded shoulder flexion positions was significantly higher than that in the sitting position (p<0.05). Conclusion: The findings suggest that ADIM in the sitting-loaded shoulder flexion position should be implemented to facilitate TrA activity.

• Archives of Plastic Surgery
• /
• 제38권3호
• /
• pp.326-328
• /
• 2011

Purpose: The anatomical anomaly of the rectus abdominis muscle and it's fascia is very rare. No case of the absence of the linea alba below the umbilicus has yet been reported. During breast reconstruction with pedicled TRAM flap, we experienced one case of absence of linea alba. Methods: The patient was a 38-years old female who underwent immediate breast reconstruction with pedicled TRAM flap after Right modified radical mastectomy in June 2010. While the TRAM flap was being elevated, bilateral twitching of the rectus abdominis muscle occurred when electrocautery was applied, and we found the absence of the linea alba below the umbilicus. Results: When the rectus abdominis muscle was exposed, the linea alba below the umbilicus was not observed, and the bilateral rectus abdominis muscle was indistinguishably fused in a gross observation. In addition, bilateral twitching of rectus abdominis muscle was simultaneously observed as one muscle unit when electrocautery was applied. As with both rectus abdominis muscles was bluntly dissected with scissors, the scanty fatty tissues were observed between the both rectus muscles, and the bilateral rectus abdominis muscle was easily separated. The flap was transposed into the corresponding defect to make breast mound. Midline fascia was fixed to the posterior rectus sheath to reconstruct smilar anatomic linea alba. Abdominal defect was reinforced by suturing between remaining anterior rectus sheath. Conclusion: As the unexpected anatomical anomaly may affect the operation outcome, surgeons should be careful when they unexpectedly encounter the anatomical anomaly during an operation. Here, we report a rare case of absence of the linea alba seen at the time of pedicled TRAM flap elevation for breast reconstruction.

• 대한물리의학회지
• /
• 제15권2호
• /
• pp.49-56
• /
• 2020

PURPOSE: This study examined the difference in muscle activity of the trunk and legs during flat walking with or without an abdominal drawing-in maneuver. METHODS: This study was conducted on 15 healthy males and eight females who were attending D University in Busan. This experiment was conducted after 15 minutes of abdominal drawing-in training using a pressure biofeedback unit before the experiment, and the difference in the muscle activity of the trunk and legs during flat walking with or without an abdominal drawing-in technique was investigated. Surface electromyography was used, and the electrode attachment site was the right sternocleidomastoid muscle, splenius capitis muscle, rectus abdominis muscle, external abdominal oblique muscle, transverse abdominis muscle, erector spinae muscle, vastus medialis muscle, and vastus lateralis muscle (TM DTS, Noraxon, USA). The data were analyzed statistically using a paired t-test on SPSS version 18.0 (IBM). RESULTS: The muscle activity of the rectus abdominis muscle, external abdominal oblique muscle, transverse abdominis muscle, vastus medialis muscle were increased significantly and maintained more than walking without maintaining an abdominal drawing-in maneuver (p < .05). Moreover, muscle activity of the erector spinae muscle was decreased significantly and maintained more than walking without maintaining an abdominal drawing-in maneuver (p < .05). CONCLUSION: Maintaining an abdominal drawing-in maneuver during flat walking is more effective during walking training.

• 대한통합의학회지
• /
• 제10권4호
• /
• pp.187-197
• /
• 2022

Purpose: This study aimed to investigate the changes in the muscle activity of the trunk stabilizer muscles before and after incorporating Pilates breathing during three types of Pilates chair exercises. Methods: This study included 33 healthy men and women in their 20's; they were recruited according to the inclusion and exclusion criteria. sEMG was used to measure the changes in the muscle activity in the internal oblique/transverse abdominis, rectus abdominis, and erector spinae during the three types of Pilates chair movements (footwork, twist footwork, and bridging) without and with the Pilates breathing integration. The muscle activities of the trunk stabilizers between without and with Pilates breathing were statistically analyzed and compared. Results: The internal oblique/transverse abdominis showed an increase and a significant difference in the muscle activity in all three movements of footwork, twist footwork, and bridging after the Pilates breathing integration (p<.001). The muscle activity of the rectus abdominis (p<.05) and the erector spinae (p<.05) also increased and showed a significant difference after the Pilates breathing incorporation, except in the bridging movement for the erector spinae. The increase in the rate after integrating Pilates breathing was relatively greater in internal oblique/transverse abdominis than in other muscles. Conclusion: When Pilates breathing was applied, the activities of the trunk stabilizer muscles increased significantly and immediately in all three movements of Pilates chair footwork, twist footwork, and bridging. This means that the use of breathing is expected to have a positive and immediate effect on the activation of trunk stabilizers, thus indicating that it can possibly be an effective re-enforcing tool to promote trunk stability when it is integrated to the Pilates chair exercise. Incorporating Pilates breathing also seemed to have a tendency to activate the deep trunk stabilizer muscles more than the superficial stabilizer muscles.

• Archives of Plastic Surgery
• /
• 제40권4호
• /
• pp.359-366
• /
• 2013

Background Pedicled transverse rectus abdominis musculocutaneous flaps typically sacrifice the entire muscle. In our experience, the lateral strip of the rectus abdominis muscle can be spared in an attempt to maintain function and reduce morbidity. When the intercostal nerves are injured, muscle atrophy appears with time. The severed intercostal nerve was reinserted into the remnant lateral strip of the rectus abdominis muscle to reduce muscle atrophy. Methods The authors retrospectively reviewed 9 neurotized cases and 10 non-neurotized cases. Abdominal computed tomography was performed to determine the area of the rectus muscles. Electromyography (EMG) was performed to check contractile function of the remnant muscle. A single investigator measured the mean areas of randomly selected locations (second lumbar spine) using ImageJ software in a series of 10 cross-sectional slices. We compared the Hounsfield unit (HU) pre- and postoperatively to evaluate regeneration quality. Results In the neurotization group, 7 of 9 cases maintained the mass of remnant muscle. However, in the non-neurotization group, 8 of 10 lost their mass. The number of totally atrophied muscles in each of the two groups was significantly different (P=0.027). All of the remnant muscles showed contractile function on EMG. The 9 remaining remnant rectus abdominis muscles showed declined the HU value after surgery but also within a normal range of muscle. Conclusions Neurotization was found to be effective in maintaining the mass of remnant muscle. Neurotized remnant muscle had contractile function on EMG and no fatty degeneration by HU value.