Repair of a large congenital diaphragmatic defect with a reverse latissimus dorsi muscle flap

Advances in neonatal care have led to an increase in the survival rate of children with large congenital diaphragmatic defects. Reconstruction by direct closure is not usually possible and surgical correction in the newborn consists of synthetic patch closure. Recurrence and complications are high w...

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Bibliographic Details
Published in:Microsurgery 2008, Vol.28 (2), p.85-88
Main Authors: Barbosa, Rui F., Rodrigues, Jorge, Correia-Pinto, Jorge, Costa-Ferreira, António, Cardoso, Augusta, Reis, Jorge C., Amarante, José M.
Format: Article
Language:English
Subjects:
Hernia, Diaphragmatic - surgery
Hernias, Diaphragmatic, Congenital
Humans
Infant, Newborn
Male
Microsurgery - methods
Muscle, Skeletal - innervation
Muscle, Skeletal - surgery
Nerve Transfer
Phrenic Nerve - surgery
Reconstructive Surgical Procedures - methods
Recurrence
Reoperation
Surgical Flaps - innervation
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Summary:Advances in neonatal care have led to an increase in the survival rate of children with large congenital diaphragmatic defects. Reconstruction by direct closure is not usually possible and surgical correction in the newborn consists of synthetic patch closure. Recurrence and complications are high with this technique and a latter reconstruction with living tissue is now advocated. We report a case of congenital diaphragmatic hernia treated initially by synthetic patch closure and 10 months latter, after a recurrence, with a reinnervated reverse latissimus dorsi (RLD) flap. We used an end‐to‐side neural coaptation of the thoracodorsal nerve to the phrenic nerve. The result was satisfactory, with remission of symptoms and improvement in growth and development, with permanent pleuro‐peritoneal separation, normal lung growth, and apparent neodiaphragmatic function. © 2008 Wiley‐Liss, Inc. Microsurgery, 2008.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.20455