The split abdominal wall muscle flap repair for large congenital diaphragmatic hernias on extracorporeal membrane oxygenation.
BACKGROUND
Numerous techniques exist for repairing large congenital diaphragmatic hernias (CDHs) including prosthetic patches, tissue-engineered grafts, and various muscle flaps. A split abdominal wall muscle flap is a simple, durable way to repair a large diaphragmatic hernia. This technique has not gained widespread use, and some have suggested that it would be inappropriate in the setting of extracorporeal membrane oxygenation (ECMO) because of bleeding risk. We present our series of diaphragmatic hernias with a focus on those repaired with the split abdominal wall technique while on ECMO.


METHODS
A retrospective, single-institution chart review was performed on all patients who underwent surgical repair for CDH over 6 years beginning in August 2000.


RESULTS
Seventy-five patients underwent repair. Sixteen were performed with patients on ECMO. Of these, 4 were closed primarily, 7 used a prosthetic patch, and 5 used a split abdominal wall muscle flap. Two patients in the prosthetic group developed a recurrent hernia, and 2 required reoperation for bleeding while on ECMO. No reoperations for bleeding were required in the abdominal muscle flap group.


CONCLUSIONS
The split abdominal wall muscle flap can be safely performed on anticoagulated patients. We believe it is a practical option for repairing large CDHs.
Brant-Zawadzki
Peter B
PB
Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA.
Fenton
Stephen J
SJ
Nichol
Peter F
PF
Matlak
Michael E
ME
Scaife
Eric R
ER
D034861:Abdominal Wall / Q000601:surgery*; D000614:Aminocaproates / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D015199:Extracorporeal Membrane Oxygenation; D005169:Factor VIII / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use; D006400:Hematocrit; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000706:statistics & numerical data; D013526:Surgical Mesh
D000614:Aminocaproates; D000925:Anticoagulants; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen