Reconstruction of congenital agenesis of hemidiaphragm by combined reverse latissimus dorsi and serratus anterior muscle flaps.
OBJECTIVE
Diaphragmatic agenesis (DA) is a distinct clinical entity with poorer survival rate compared with patients with posterolateral diaphragmatic hernia. The large defect in DA is repaired frequently with a synthetic patch in the neonatal period. Well-known, long-term complications include recurrent hernia caused by patch dislodgement, chest wall deformation caused by noncompliant patch, and deteriorating pulmonary function. A reverse latissimus dorsi flap (RLD) allows continued growth of the reconstructed diaphragm with an intact pleuro peritoneal separation. When combined with neuroanastomosis of the phrenic and thoracodorsal nerves it has the potential to function as a native diaphragm. Incorporation of Serratus anterior (SA) muscle enables reconstruction of larger defects.


METHODS
Two cases of DA are presented. In each case the primary SILASTIC(R) (Dow Corning, Midland, MI) patch repair failed and was replaced successfully with a RLD flap reconstruction with or without incorporation of SA and neuroanastomosis.


RESULTS
Both patients recovered from surgery with minimal morbidity. The reconstructed diaphragm is intact at long-term follow-up. There is marked improvement of growth of the infants, respiratory difficulties, and chest wall deformity.


CONCLUSIONS
This technique is recommended in DA when the synthetic patch fails.
Samarakkody
U
U
Department of Paediatric Surgery, Waikato Hospital, Private bag 3200, Hamilton, New Zealand.
Klaassen
M
M
Nye
B
B
D001672:Biocompatible Materials; D003964:Diaphragm / Q000002:abnormalities* / Q000601:surgery*; D004129:Dimethylpolysiloxanes; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D012828:Silicones; D013524:Surgical Flaps; D013908:Thoracotomy / Q000379:methods; D017211:Treatment Failure
D001672:Biocompatible Materials; D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon