Abdominal muscle flap repair for large defects of the diaphragm

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.

Effectiveness of diaphragmatic repair using an abdominal muscle flap in patients with recurrent congenital diaphragmatic hernia

“…There are very few reports in which this procedure was applied to a Re-CDH with a large diaphragmatic defect [9]. The AMF procedure also has some benefits in that this muscle flap is the patient's own vascularized muscle and can easily close the defect without tension, resulting in less chance of a recurrence of CDH [6][7][8][9][10][11]. In fact, in all 4 of the patients on whom we performed this procedure, we have not experienced any recurrence.…”

“…The disadvantage of it is thought to be performing by the thoracic approach and the deformity of the thoracic shape after the procedure [2,5]. In contrast, the AMF we used is also known to be a primary procedure for a CDH with a large diaphragmatic defect [6][7][8][9][10][11]. There are very few reports in which this procedure was applied to a Re-CDH with a large diaphragmatic defect [9].…”

“…Alternatively, some procedures using the patient's own muscle, including the AMF procedure, are also sometimes used in a small population of Re-CDH [5][6][7][8][9][10][11][12]. Repair using a reversed latissimus dorsi muscle flap is a well-known procedure for Re-CDH [5,12].…”

“…reported to use for the neonates or delayed onset CDH patients [6][7][8][9][10][11]. Until now, there have been few reports regarding the use of this AMF in the treatment of Re-CDH [9].…”

Congenital diaphragmatic hernia: a case report and review of literature

“…Large defects are closed by a prosthetic patch [11,12] sutured to the rims of the orifice with interrupted sutures.Patch closure may increase the risk of re-herniation [13][14][15][16]. Abdominal wall or latissimus dorsi flaps may be used for CDH repair [17][18][19][20]. Right sided defects and herniation of stomach or liver confer a poor prognosis [2].…”