Surgical Treatment of Diaphragmatic Agenesis by Transposition of a Muscle Flap: Report on 15 Cases

Abstract

Between 1987 and 1996 the transposition of a muscle flap using the anterolateral abdominal wall (the internal oblique and transversus abdominus muscle) has been used for the surgical treatment of fifteen cases of diaphragmatic agenesis. There are several advantages of this technique: a more accurate reconstruction of the diaphragmatic dome, a better adapted muscle flap, good tolerance and evolution as a result of the use of autologous material with thus less risk of recurrence and/or infection. The disadvantages are represented by the nine cases of abdominal herniation at the site of the muscle flap, three of which necessitated secondary surgical treatment. Nine children survived this treatment, six died following severe cardio-pulmonary complications associated with this malformation.

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].…”

Abdominal muscle flap repair for large defects of the diaphragm

“…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][2][3][4][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.…”