Latissimus dorsi reverse flap to substitute the diaphragm after extrapleural pneumonectomy

Background. The standard procedure for diaphragm reconstruction after extra pleural pneumonectomy for a malignancy consists of the use of prosthetic pa tches. Our original technique utilizing the reverse nap of the latissimus d orsi is evaluated. Methods. Once the extrapleural pneumonectomy is performed, the distal porti on of the latissimus dorsi, which has been divided with a standard posterol ateral thoracotomy at the level of the fifth to sixth rib, is elevated into the chest through the passage obtained by resection of the tenth rib and s utured to the lower pericardium and to the chest wall. Nine patients were e valuated. Results. No operative death occurred. No flap-related complication nor infe ction was postoperatively assessed. Six patients received adjuvant radiothe rapy. No late complication was observed. Conclusions. The distal latissimus dorsi can be used for total reconstructi on of one hemidiaphragm, ensuring a watertight separation between the pleur al and peritoneal cavities and avoiding paradoxical respiratory motion. In our opinion, the technique was easier, faster, and more reliable than the s tandard procedure employing prosthetic materials. We recommend that the pro cedure be integrated with the standard technique of extrapleural pneumonect omy. (C) 2000 by The Society of Thoracic Surgeons.