title: Musculoskeletal deformities following repair of large congenital diaphragmatic hernias.
abstract: OBJECTIVE
  Large congenital diaphragmatic hernias (CDH) can be repaired with either a muscle flap or prosthetic patch. The purpose of this study was to assess the frequency and severity of scoliosis, chest wall, and abdominal wall deformities following these repairs.
  
  
  METHODS
  Neonates who underwent CDH repair (1989-2012) were retrospectively reviewed. We then validated our retrospective review by comparing results of a focused radiologic evaluation and clinical examination of patients with large defects seen in prospective follow-up clinic. Tests for association were made using Fisher's exact test.
  
  
  RESULTS
  236 patients survived at least 1year. Of these patients, 30 had a muscle flap, and 13 had a patch repair. Retrospectively, we identified pectus in 9% of primary repairs, 47% of flap repairs, and 54% of patch repairs. We identified scoliosis in 7% of primary repairs, 13% of flap repairs, and 15% of patch repairs. Prospectively, 75% of flap patients and 67% of patch patients had pectus and 13% of flap patients and 33% of patch patients had scoliosis. There was no significant difference between flap and patch patients.
  
  
  CONCLUSIONS
  Scoliosis and pectus deformity were common in children with large CDH. The operative technique did not appear to affect the incidence of subsequent skeletal deformity.
authors.affiliation: University of Utah, Primary Children's Hospital, Division of Pediatric Surgery, Salt Lake City, UT, USA. Electronic address: Katie.Russell@hsc.utah.edu.
authors.forename: Katie W
authors.initials: KW
authors.lastname: Russell
authors.affiliation: University of Utah, Primary Children's Hospital, Division of Pediatric Surgery, Salt Lake City, UT, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.affiliation: University of Utah, Primary Children's Hospital, Division of Pediatric Surgery, Salt Lake City, UT, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rollins
authors.affiliation: University of Utah, Primary Children's Hospital, Division of Pediatric Surgery, Salt Lake City, UT, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Hedlund
authors.affiliation: University of Utah, Primary Children's Hospital, Division of Pediatric Surgery, Salt Lake City, UT, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Scaife
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: CDH; Pectus carinatum; Pectus excavatum; Scoliosis; Split-abdominal wall muscle flap