PURPOSE: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. METHODS: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. RESULTS: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9-3.4cm and 1.8-3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7-7.0cm on medial margin and 6.2cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8-5.6cm on medial margin and 2.7-6.2cm on lateral margin. CONCLUSION: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8cm on medial margin and 1.9cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.
Abdomen ; Cadaver ; Epigastric Arteries ; Female ; Glycosaminoglycans ; Mammaplasty ; Muscles ; Rectus Abdominis ; Umbilicus

OBJECTIVE: This study was conducted to investigate satisfaction surveys of the emergency medical system in Korea administered to both members of the Korean Society of Emergency Medicine and patients and their guardians. METHODS: The joint survey was conducted by the Korea Scientist Journalists Association and the Public Affairs Committee of the Korean Society of Emergency Medicine. Questionnaires administered to each group included questions about the general environment, safety, and overcrowding. Satisfaction of medical staffs and awareness of cardiopulmonary resuscitation were only included in the patient questionnaire, while public health was only surveyed in the member questionnaire. The satisfaction was evaluated on a 5-point scale. RESULTS: Patient questionnaires were answered by 20 of 413 national emergency medical centers, and about 4.3% of the medical institutions participated in the questionnaire. A total of 704 reply sheets were returned by patients. Member questionnaires were answered by 280 of the 1,108 members (25%). Among patients, the lowest satisfaction was the item of “medical expenses,” followed by “waiting time”. Among providers, the lowest satisfaction was “appropriateness of medical staff”, while the highest complaint was “overcrowding.” CONCLUSION: Emergency care users had the lowest satisfaction with “medical expenses,” while members had the lowest satisfaction with “lack of manpower” and were most dissatisfied with “violence” and “overcrowding.”
Cardiopulmonary Resuscitation ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Health Care Surveys ; Humans ; Job Satisfaction ; Joints* ; Korea* ; Medical Staff ; Patient Satisfaction ; Public Health