Reconstruction of congenital agenesis of hemidiaphragm by combined reverse latissimus dorsi and serratus anterior muscle flaps☆
Section snippets
Case 1
A male infant weighing 2,542 g (small for gestational age) was delivered by normal vaginal delivery at 38 weeks' gestation. Surgery was performed after initial stabilization over 2 weeks. Agenesis of the left hemidiaphragm was diagnosed during surgery, and a SILASTIC® (Dow Corning, Midland, MI) patch was used successfully for reconstruction. The large diaphragmatic defect had a 5-mm anterior lip with no identifiable posterior or medial diaphragmatic rim. The patch was sutured with nonabsorbable
Discussion
Management of congenital diaphragmatic hernia continues to improve. The common place posterolateral defects are repaired by approximating the available diaphragmatic tissue around the defect. However, rarer complete diaphragmatic agenesis poses a challenge to pediatric surgeons because of the improved survival rate of these babies. Where a significant portion of the diaphragmatic rim is absent, the approximation even under tension is difficult, and babies initially are treated with synthetic
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Cited by (28)
Pectoralis Major and Serratus Anterior Muscle Flap for Diaphragmatic Reconstruction
2022, Annals of Thoracic SurgeryCitation Excerpt :The first choice for diaphragmatic reconstruction involves using artificial materials.6 However, reconstruction with these materials requires careful use indications considering infection if postoperative radiotherapy is planned or if there is a high possibility of tumor recurrence.1-5,7 In contrast, autologous tissue reconstruction with blood perfusion is less likely to cause postoperative infection.1-5
Porcine bladder extracellular matrix as a tissue regenerative strategy in a neonate with omphalocele and diaphragmatic agenesis
2021, Journal of Pediatric Surgery Case ReportsCitation Excerpt :However, placement of the prosthetic patch in a cone-shaped three-dimensional patch has led to a reduction in rates of recurrence compared to standard patch placement [7]. Muscle flap repair can be fashioned from the internal oblique and transversus abdominis muscle (split abdominal wall muscle flap) or the latissimus dorsi with optional incorporation of serratus anterior muscle (reverse latissimus dorsi repair) [4,6]. Staged reconstruction with prosthetic patch closure and subsequent reverse latissimus dorsi repair once clinical signs of patch disproportion occur have reported good results with proportionate muscle flap growth and no evidence of paradoxical chest wall movement [8].
Whole organ and tissue reconstruction in thoracic regenerative surgery
2013, Mayo Clinic ProceedingsCitation Excerpt :However, the use of local muscle flaps can reduce the abdominal domain. This may leave a large thoracic cavity on the side of the hernia, with an associated risk of atrophy of a denervated muscle.79-82 Engineered diaphragm muscle tissue must provide a patch of functional skeletal muscle, and it should withstand atrophy and carry a low risk of infection.
Innovations in the Surgical Management of Congenital Diaphragmatic Hernia
2012, Clinics in PerinatologyCitation Excerpt :Based on the lumbar perforating blood vessels, the reverse latissimus dorsi muscle provides a wide pedicle for a tension-free repair. For very large defects, such as agenesis of the diaphragm, combined use of the latissimus dorsi and serratus anterior muscles has been described.54–56 Although autologous muscle flaps are vascularized and tend to grow with the child, these diaphragmatic reconstructions with latissimus dorsi/serratus muscle flaps are typically small and have demonstrated atrophy over time because of denervation of the graft.
Reconstruction of a large diaphragmatic defect in a kitten using small intestinal submucosa (SIS)
2009, Journal of Feline Medicine and SurgerySurgical management of neonates with congenital diaphragmatic hernia
2007, Seminars in Pediatric SurgeryCitation Excerpt :The initial repair in these patients should be considered the first operation of a staged procedure. Case reports of the use of reverse latissimus dorsi and serratus anterior muscle flaps hold promise in these difficult cases, as the native tissue may offer the advantage of continued growth of the reconstructed diaphragm.32 If closure of the abdominal fascia is likely to increase intraabdominal pressure enough to exacerbate the respiratory compromise, the fascia should be left open.
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Address reprint requests to Udaya Samarakkody, Department of Paediatric Surgery, Waikato Hospital, Private bag 3200, Hamilton, New Zealand.