Reconstruction of congenital agenesis of hemidiaphragm by combined reverselatissimus dorsi and serratus anterior muscle flaps

Background/Purpose: Diaphragmatic agenesis (DA) is a distinct clinical enti ty with poorer survival rate compared with patients with posterolateral dia phragmatic hernia. The large defect in DA is repaired frequently with a syn thetic patch in the neonatal period. Well-known, long-term complications in clude recurrent hernia caused by patch dislodgement, chest wall deformation caused by noncompliant patch, and deteriorating pulmonary function. A reve rse latissimus. dorsi flap (RLD) allows continued growth of the reconstruct ed diaphragm with an intact pleuro peritoneal separation. When combined wit h neuroanastomosis of the phrenic and thoracodorsal nerves it has the poten tial to function as a native diaphragm. Incorporation of Serratus anterior (SA) muscle enables reconstruction of larger defects. Methods: Two cases of DA are presented. In each case the primary SILASTIC(R ) (Dow Corning, Midland, MI) patch repair failed and was replaced successfu lly with a RLD flap reconstruction with or without incorporation of SA and neuroanastomosis. Results: Both patients recovered from surgery with minimal morbidity. The r econstructed diaphragm is intact at longterm follow-up. There is marked imp rovement of growth of the infants, respiratory difficulties, and chest wall deformity. Conclusion: This technique is recommended in DA when the synthetic patch fa ils. J Pediatr Surg 36:1637-1640. Copyright (C) 2001 by W.B. Saunders Compa ny.