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백승준,허찬영,오갑성,Baek, Seong-Jun,Heo, Chan-Yeong,Oh, Kap-Sung 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.2
The lower extremity injuries are extremely increasing with the development of industrial & transportational technology. For the lower extremity injuries that result from high-energy forces, particularly those in which soft tissue and large segments of bone have been destroyed and there is some degree of vascular compromise, the problems in reconstruction are major and more complex. In such cases local muscle coverage is probably unsuccessful, because adjacent muscles are destroyed much more than one can initially expect. Reconstruction of the lower extremity has been planned by dividing the lower leg into three parts traditionally The flaps available in each of the three parts are gastrocnemius flap for proximal one third, soleus flap for middle one third and free flap transfer for lower one third. Microvascular surgery can provide the necessary soft tissue coverage from the remote donnor area by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde flow flaps are well established in island flaps. Retrograde flow anastomosis could not interrupt the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. During 5 years, from March 1993 to Feb. 1998, we have done 68 free flap transfers in 61 patients to reconstruct the lower extremity. From analysis of the cases, we concluded that for the reconstruction of the lower extremity, free flap transfer yields a more esthetic and functional results.
백승준 ( Seung Jun Baek ),김영훈 ( Young Hoon Kim ),김한성 ( Han Sung Kim ),최영진 ( Young Jin Choi ),한휘종 ( Whie Jong Han ),윤병준 ( Byoung Jun Yoon ),우정식 ( Jung Sik Woo ),김효정 ( Hyo Jeong Kim ) 한국병원경영학회 2014 병원경영학회지 Vol.19 No.3
This study, targeting Korean tertiary hospitals and general hospitals, aims to analyze how value chain model inhealth and medical institution suggested by Duncan and else influences on hospital management. A survey wasconducted to verify the actual proof analysis of this study model. 880 questionnaires were distributed to entire 88hospitals and 739 copies were returned from 76 hospitals. This study mainly consists of three steps to analyze theeffect value chain activity has on management performance of general hospitals. For the first step, we analyzedthe effects service delivery activity has on management performance. For the second step, we analyzed theeffects service support activity has on management performance and for the third, we analyzed the effectsinteraction between service delivery activity and service support activity has on management performance. Themain results of this study are as follows. First, in terms of the management performance of scale, the factors whichinfluenced on daily charge of outpatient were service activity before treatment, at the moment of treatment andvalue chain activity, while more important factors in daily charge of inpatient were organizational culture,organizational structure and value chain activity. In terms of management performance of quality, the factors whichinfluenced on the first medical examination rate of outpatient were service activity before, at the moment of andafter treatment, while activity at the moment of treatment, organizational structure, and value chain activity which isinteraction were more important factors in average length of stay. In terms of non-financial performance, themanagement performance factors which influenced on job satisfaction were service activity at the moment of, afterthe treatment and value chain activity, while organizational culture, strategy resources and value chain activitywhich is interaction were more important factors in job commitment. Secondly, all the service support activity,service delivery activity and value chain activity had statistically significant effect on management performance.Among the three factors, service support activity had relatively high effect than others.