• 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.

• The Journal of Korean Physical Therapy
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• 제25권6호
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• pp.405-410
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• 2013

Purpose: Most studies have reported that the abdominal muscle thickness differs according to gender but none of these studies reported a gender difference in the thickness of the multifidus and erector spine. The spinal alignment is affected by the left and right balance in the trunk muscle. The aim of this study was to identify the trunk muscle symmetry according to gender and the correlations of the trunk muscle thickness with spinal alignment. Methods: Forty three subjects(27 males and 16 females) were enrolled in this study. The trunk muscle thickness was measured by ultrasonography. The trunk muscle, which consisted of the rectus abdominis (RA), external oblique abdominis (EOA), internal oblique abdominis (IOA), transverse abdominis (TrA), erector spine (ES), and multifidus (MF), was measured. The spinal alignment was measured by Formetric-III 3D analysis. The dependent variables of the spinal alignment were the trunk imbalance, trunk inclination, lateral deviation, and surface rotation. Results: The muscle thickness of the EOA muscle increased more significantly in the right side than the left side (p<0.05). Each left and right difference in the muscle thickness between the male and female group showed a significant difference (p<0.05) except for the TrA thickness. Significant positive correlations were observed between the ES and lateral deviation and between the TrA with trunk imbalance. Conclusion: These results suggest that asymptomatic men have a greater trunk muscle thickness than women but there was no difference between the left and right in healthy adults. The trunk muscle thickness of ES, TrA is related by the spinal alignment.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.469-473
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• 2006

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. Methods: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. Results: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. Conclusion: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.

• The Journal of Korean Physical Therapy
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• 제32권4호
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• pp.228-232
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• 2020

Purpose: This study examined the electromyography (EMG) activity of the abdominal muscles and the ratio of the oblique abdominal muscle activity to the rectus abdominis muscle during a single-leg holding position with isometric shoulder abduction (SLHISA) in the supine position on a foam roller. Methods: Nineteen healthy males were recruited to the study. Each subject was asked to lay on a round foam roller and perform singleleg (nondominant) holding with contralateral shoulder abduction to one of three angles (45°, 90°, or 135°) in random order. The surface EMG signals of the bilateral rectus abdominis (RA), external oblique abdominis (EO), and combined internal oblique abdominis (IO) and transverse abdominis (TrA) muscle were collected during the tasks. The EO/RA and (IO & TrA)/RA ratios were determined using surface EMG. One way repeated measure ANOVA with three SLHISAs was used to assess the significant abdominal muscle EMG activity and the ratio of the oblique abdominal muscles activity to the RA muscle. The statistical significance level was p<0.05. Results: The results were as follows. The SLHISA 135° showed significantly higher EMG activity of both RAs, left EO, and right IO & TrA muscles (p<0.05). The right EO and left IO and TrA muscles/RA were significantly different among the SLHISA angles. The SLHISA 45° showed a significantly greater ratio of right EO/RA and left IO & TrA/RA (p<0.05). Conclusion: SLHISA on a foam roller is useful for lumbopelvic stabilization exercise by increasing the activity and recruiting a specific pattern of the oblique abdominal muscle.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.88-91
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• 2020

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignancy. This report describes the case of an unusual extensive SCC involving the whole hemiface, which required reconstruction with a combination of a dual vascular free transverse rectus abdominis muscle (TRAM) flap and a skin graft. A 79-year-old woman visited our hospital with multiple large ulcerated erythematous patches on her right hemiface, including the parieto-temporal scalp, bulbar and palpebral conjunctiva, cheek, and lip. A preliminary multifocal biopsy was performed in order to determine the resection margin, and the lesion was resected en bloc. Orbital exenteration was also performed. A free TRAM flap was harvested with preserved bilateral pedicles and was anastomosed with a single superior thyroidal vessel. The entire TRAM flap survived. The final pathological examination of the resected specimen confirmed that there was no regional nodal metastasis, perineural invasion, or lymphovascular involvement. The patient was observed for 6 months, and there was no evidence of local recurrence. Usage of a TRAM flap is appropriate for hemifacial reconstruction because the skin of the abdomen matches the color and pliability of the face. Furthermore, we found that the independent attachment of two extra-flap anastomoses to a single recipient vessel can safely result in survival of the flap.

• The Journal of Korean Physical Therapy
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• 제31권5호
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• pp.298-303
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• 2019

Purpose: This study examined the effects of slashpipe exercise on reducing the thickness of the left and right external oblique, internal oblique, transverse abdominis, erector spinae, and multifidus muscles. Methods: A total of 29 healthy adult men and women were included in the study. They performed trunk flexion in the supine position and trunk extension in the prone position with a slashpipe and weight bar. The external oblique, internal oblique, and transverse abdominis muscles were measured in the supine position, while the erector spinae and multifidus muscles were measured in the prone position. The data were analyzed using the SPSS ver 21.0 statistical program. The difference in thickness between the right and left sides of the trunk muscle was analyzed by repeated measures analysis. The statistical significance level was set to p<0.05. Results: The results showed that the slashpipe exercise reduced significantly the difference in thickness of the oblique internus and erector spinae muscles compared to the weight bar exercise. Conclusion: The chaotic fluidity of the fluid filled inside the slashpipe could be used as sensory feedback information on body mal-alignment, which would have positively affected the symmetrical contraction of the trunk muscles as a trigger for self-correction. Therefore, it will have a useful effect not only on the health of the general public, but also on low back patients and athletes with muscle asymmetry.

• 대한통합의학회지
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• 제6권4호
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• pp.127-137
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• 2018

Purpose : The purpose of this study has been performed to find the effect of horseback riding simulation training on the thickness of abdominal muscles and functional balance in children with down syndrome. Methods : This study included 10 children with down syndrome aged between 7 and 13 years. Both groups received regular neurodevelopmental treatment, also experimental group was performed for additional 15 minutes horseback riding simulation training for twice a week during 8 weeks. We measured the thickness of abdominal muscles by using ultrasonography and measured of functional balance by using Pediatric Berg's Balance for the subjects agreed to the before, after 4 weeks and 8 weeks the training. Results : There were no significant difference in the thickness of the internal oblique and external oblique muscles. There were significant difference in transverse abdominis thickness and functional balance that experimental group had increased average than control group after 4 weeks and 8 weeks training Conclusion : Horseback riding simulation training has a positive effect on the improvement of transverse abdominis muscle thickness and functional balance in children with down syndrome.

• PNF and Movement
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• 제9권3호
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• pp.1-9
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• 2011

Purpose : The purpose of this study was to find the effects of the transverse abdominis/internal abdominal oblique (TrA/IO), multifidus (MF) muscles while stabilization exercise was performed in a four-point kneeling position on the unstable surface. Methods : Twenty healthy adults volunteered to participate in this study. Each subject was instructed regarding maximum voluntary isometric contractions (MVIC) and stabilization exercise in four-point kneeling on the unstable surface. While MVIC and stabilization exercise of individual muscles were being performed, activation of the muscles was measured using surface electromyography (EMG). Activation of the muscles while performing stabilization exercise in four-point kneeling on the unstable surface was normalized to a percentages of the MVIC. Results : TrA/IO, MF muscles showed no significant differences among the surfaces. Conclusion : Activation of the trunk muscles while performing stabilization exercise in four-point kneeling does not effect on the surface.

• Archives of Plastic Surgery
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• 제49권4호
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• pp.482-487
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• 2022

In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.