title: Diaphragmatic rupture: Is management with biological mesh feasible?
abstract: BACKGROUND
  Blunt diaphragmatic rupture is a rare event that may occur after traumatic injury. Due to its rarity and difficulty in diagnosing, delayed detection of diaphragmatic injuries can occur. Management involves repair of the diaphragmatic defect via trans-thoracic and/or trans-abdominal approaches. Most small repairs may be repaired primarily, larger defects have been historically repaired with mesh.
  
  
  METHODS
  We report a case series of five patients with diaphragmatic injuries all repaired with biologic mesh via both trans-thoracic and trans-abdominal approaches.
  
  
  CONCLUSIONS
  Delayed presentation is the single most important contributor to increased morbidity and mortality in patients with blunt diaphragmatic rupture. Our case series corroborates other findings that patients with blunt diaphragmatic ruptures are at high risk for infection and thus may be repaired with use of biologic mesh versus the traditional use of synthetic mesh. This can be done without high rates of recurrence or complications from use of biologic mesh.
  
  
  CONCLUSIONS
  In our series, we successfully repaired 5 diaphragmatic defects with the use of biologic mesh. With follow-up as much as 4 years out, none of our patients have had an infectious complication with the use biologic mesh and there is no evidence of recurrence or eventration. The use of biologic mesh is an acceptable alternative to the traditional use of synthetic mesh in the repair of both acute and chronic diaphragmatic defects.
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, United States.
authors.forename: Omar
authors.initials: O
authors.lastname: Al-Nouri
authors.forename: Brett
authors.initials: B
authors.lastname: Hartman
authors.forename: Robert
authors.initials: R
authors.lastname: Freedman
authors.forename: Casey
authors.initials: C
authors.lastname: Thomas
authors.forename: Thomas
authors.initials: T
authors.lastname: Esposito