Staged reconstruction of large congenital diaphragmatic defects with synthetic patch followed by XXXX muscle.

@entity1 @entity1514 @entity2914 @entity764 @entity358 @entity736 @entity16757
BACKGROUND/PURPOSE: Synthetic repair of large congenital diaphragmatic defects (>90%) invariably will lead to recurrence, progressive @entity764 , and @entity358 . Staged reconstruction with living, growing tissue can help avoid these complications. METHODS: Between November 1995 and December 1999, 5 @entity1 (median age, 25 months) with diaphragmatic agenesis underwent staged replacement with a @entity16757 ( @entity16757 ) flap. All required extracorporeal membrane oxygenation (ECMO) support at birth followed by synthetic patch ( @entity736 or @entity736 ) diaphragm closure. Clinical evidence of patch disproportion, including recurrence (n = 3), @entity764 (n = 3), radiographic findings (n = 2), and restrictive respiratory patterns (n = 1), provided indication for replacement. The procedure involves removal of the original patch via thoracotomy followed by transposition of a @entity16757 flap (based on the paraspinous and intercostal perforating vessels) into the defect through the bed of the 10th rib. Two @entity1 underwent concomitant fundoplication. RESULTS: @entity16757 flap was completed successfully in all 5 @entity1 . Median length of stay after the procedure was 8 days. With a mean follow-up of 28 months (15 to 64 months), there have been no recurrences and no complications related to the procedure. Respiratory status and @entity764 have improved. There was neither evidence of paradoxical chest wall movement nor obvious limitation of the ipsilateral upper extremity on physical examination. The @entity16757 flaps have grown proportionately to the @entity1 and remained at a stable level on chest x-ray. CONCLUSIONS: Staged reconstruction with patch closure followed by definitive @entity16757 flap repair is a safe and highly effective treatment option in @entity1 with diaphragmatic agenesis. A planned replacement should be considered in all @entity1 with severe @entity2914 and patch closure before the development of @entity1514 .
