Abstract
Introduction Repair of large congenital diaphragmatic hernias (CDHs) is challenging. As primary
repair is not always feasible, patches are commonly used. An alternative treatment
is split abdominal wall muscle flap repair, which uses vascularized autologous tissue.
The aim of this study was to analyze the long-term outcome of large CDH defects undergoing
split abdominal wall muscle repair.
Materials and Methods This is a retrospective review (2003–2016) of large CDH treated by split abdominal
wall muscle flap repair.
Results In a total of 107 CDH patients, the abdominal muscle flap technique was used in 10
(9.3%); 7 had been prenatally treated with tracheal occlusion. Two patients experienced
recurrence at 2 months and 6 years, respectively. Only one patient required abdominoplasty
due to abdominal wall muscle weakness. Two patients developed progressive scoliosis;
one of them required orthopaedic treatment. Minor chest wall deformities were detected
in seven, but only one required orthopaedic treatment. The lung-to-head ratio was
0.79 in patients developing musculoskeletal deformities, and 1.5 in those without
this complication (p < 0.05). Median follow-up was 11.2 years (3.5–14.2), and all patients were alive
at the time of writing this article.
Conclusion The split abdominal wall muscle flap technique is a valid option for repair of large
CDH. Associated musculoskeletal deformities seem to be influenced not only by the
repair technique used but also by the degree of pulmonary hypoplasia and inherent
pathophysiological changes.
Keywords
large congenital diaphragmatic hernia - split abdominal wall muscle flap repair -
musculoskeletal deformities - diaphragmatic agenesis
