Abdominal muscle flap for repair of large congenital diaphragmatic hernia: Ultrasound evidence for retained motor muscle function

Congenital diaphragmatic hernia (CDH) occurs in approximately one of 3500 live births. It includes a congenital defect of the diaphragm through which bowel and other abdominal organs herniate into the thoracic cavity. Pulmonary hypoplasia is an essential feature of the anomaly, with related overload of the right side of the heart. Most CDHs can be sutured directly after initial stabilization of the cardiopulmonary condition. However, in diaphragmatic agenesis or a large defect, alternative techniques like prosthetic patches or tissue flaps are needed. Here we describe three cases, where abdominal muscle flaps were used for diaphragmatic reconstruction. In one of the patient's dynamic ultrasound of the reconstructed diaphragm, functional ventilatory movements were demonstrated, suggesting improved functional results. None of the three patients developed recurrence, and the abdominal bulge on the side of the flap is slowly improving in the surviving patients. Keywords: CDH, Congenital diaphragmatic hernia, Abdominal muscle flap, Ventilatory movement, Functional result, Dynamic ultrasoun