Abstract
Repair of a large diaphragmatic defect in congenital diaphragmatic hernia (CDH) and eventration of the diaphragm (DE) is difficult, especially when this is an unexpected finding at surgery. A patch of synthetic material may not be available at short notice, especially in developing countries. We describe the repair of nine such defects by using an abdominal muscle flap comprising the transversus abdominis and internal oblique muscles based on the intercostal and subcostal vessels. Although reports of similar flap repairs have been published in the literature [1–5], these employed a subcostal incision for abdominal entry, which we believe jeopardizes the flap’s vascularity. Thus, we prefer to use an upper abdominal midline incision for abdominal entry in all cases of CDH and DE.
This is a preview of subscription content, log in via an institution to check access.
References
Scaife ER, Johnson DL, Meyers RL, Johnson SM, Matlak ME (2003) The split abdominal wall muscle flap—a simple, mesh-free approach to repair large diaphragmatic hernia. J Pediatr Surg 38(12):1748–1751
Simpson JS, Gossage JD (1971) Use of abdominal wall muscle flap in repair of large congenital diaphragmatic hernia. J Pediatr Surg 6(1):42–44
Rosenkrantz J, Cotton EK (1964) Replacement of left diaphragm by a pedicled abdominal muscular flap. J Thorac Cardiovasc Surg 48:912–920
Aspinall L, Ford WDA (1994) Lower abdominal muscle flap for closure of large diaphragmatic defects. Pediatr Surg Int 9:223–224
Pelizzo G, Dubois R, Laine X, Zamfirescu A, Chappuis JP (2000) Surgical treatment of diaphragmatic agenesis by transposition of a muscle flap: report of 15 cases. Eur J Pediatr Surg 10:8–11
Samarkody U, Klassen M, Nye B (2001) Reconstruction of congenital agenesis of hemidiaphragm by combined reverse latissimus dorsi and serratus anterior muscle flap. J Pediatr Surg 36(11):1637–1640
Sydorak RM, Hoffman W, Lee H, Yingling CD, Longaker M, Chang J, Smith B, Harrison MR, Albanese CT (2003) Reversed latissimus dorsi muscle flap for repair of recurrent congenital diaphragmatic hernia. J Pediatr Surg 38(3):296–300
Wallace CA, Rodsen JS (1995) Reverse, innervated latissimus dorsi flap reconstruction of congenital diaphragmatic absence. Plast Reconstr Surg 96(4):761–769
Bianchi A, Doig MC, Cohen JS (1983) The reverse latissimus dorsi flap for congenital diaphragmatic hernia. J Pediatr Surg 18(5):560–563
Lee SL, Poulos ND, Greenholz SK (2002) Staged reconstruction of large congenital diaphragmatic defects with synthetic patch followed by reverse latissimus dorsi muscle. J Pediatr Surg 37:367–370
Geisler F, Gotlieb A, Fried D (1977) Agenesis of the right diaphragm repaired with Marlex. J Pediatr Surg 12:587–588
Lally KP, Cheu HW, Vazquez WD (1993) Prosthetic diaphragm reconstruction in the growing animal. J Pediatr Surg 28(1):45–47
Newman BM, Jewett TC, Lewis A, Cerny F, Khan A, Karp M, Cooney DR (1985) Prosthetic materials and muscle flaps in the repair of extensive diaphragmatic defects: an experimental study. J Pediatr Surg 20(4):362–367
Ramadwar RH, Carachi R, Young DG (1997) Collagen-coated Vicryl mesh is not a suitable material for repairing diaphragmatic defects. J Pediatr Surg 32(12):1708–1710
Moss RL, Chen CM, Harrison MR (2001) Prosthetic patch durability in congenital diaphragmatic hernia: a long-term follow-up study. J Pediatr Surg 36(1):152–154
Schneider R, Herrington JL Jr, Granda AM (1979) Marlex mesh in repair of a diaphragmatic defect later eroding into the distal esophagus and stomach. Am Surg 45:337–339
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Joshi, S.B., Sen, S., Chacko, J. et al. Abdominal muscle flap repair for large defects of the diaphragm. Ped Surgery Int 21, 677–680 (2005). https://doi.org/10.1007/s00383-005-1438-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-005-1438-1