REVERSE, INNERVATED LATISSIMUS-DORSI FLAP RECONSTRUCTION OF CONGENITAL DIAPHRAGMATIC ABSENCE

Children with congenital diaphragmatic absence have experienced a high mortality rate regardless of early intervention due to regression to fetal circulation patterns. Advances in neonatal care, particularly ex tracorporeal membrane oxygenation, have led to the survival of childre n who previously would not have lived. With growth, the Gore-Tex patch used for emergency repair in severe cases pulls away from the rib per iosteum as a result of the expansile growth of the chest wall and the indistensibility of the patch. Recurrent herniation of abdominal conte nts ensues, slowly restricting pulmonary function and development. Whe n pulmonary function is significantly impaired, we perform a reverse l atissimus dorsi flap reconstruction with anastomosis of the thoracodor sal nerve to the phrenic nerve. Our series includes five children aged 5 to 11 months. Follow-up ranges from 22 to 50 months. Three children have proven physiologic neodiaphragmatic motion. The other two are do ing well with stable absence of paradoxical motion. There have been no complications. Long-term follow-up will be required to determine thei r eventual fate. The prognosis is encouraging.