Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1938-0763
Reconstruction of Extensive Diaphragmatic Defects Using the Rectus Abdominis Muscle and Fascial Flap
![](https://www.thieme-connect.de/media/10.1055-s-00051611/202302/lookinside/thumbnails/10-1055-a-1938-0763_22feb0013cr-1.jpg)
Abstract
Diaphragmatic reconstruction is required for extensive diaphragmatic defects associated with tumor resection. Methods using artificial mesh and autologous tissues, such as pedicled flaps, have been reported predominantly for diaphragmatic reconstruction. We present the case of a 61-year-old woman who presented with a 14 × 13 × 12 cm tumor in the abdominal cavity of the upper left abdomen on computed tomography. The diaphragm defect measuring 12 × 7 cm that occurred during excision of the malignant tumor was reconstructed using the rectus abdominis muscle and fascial flap. The flap has vertical and horizontal vascular axes; therefore, blood flow is stable. It also has the advantage of increasing the range of motion and reducing twisting of the vascular pedicles. Fascial flap does not require processing such as thinning and can be used during suture fixation. This procedure, which has rarely been reported so far, has many advantages and may be a useful option for diaphragm reconstruction.
Author Contributions
Conceptualization: S.K.; Data curation: H.S.; Formal analysis: S.K.; Funding acquisition: I.T.; Methodology: S.K., H.S., T.F., J.M., I.T.; Project administration: S.K.; Visualization: S.K., I.T.; Writing -original draft: S. K; Writing -review and editing: H.S.
Ethical Approval
This study was performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from the patient.
Patient Consent
The patient provided written informed consent for publication and use of her images.
Publication History
Received: 29 March 2022
Accepted: 30 June 2022
Accepted Manuscript online:
07 September 2022
Article published online:
01 February 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Finley DJ, Abu-Rustum NR, Chi DS, Flores R. Reconstructive techniques after diaphragm resection. Thorac Surg Clin 2009; 19 (04) 531-535
- 2 Hallock GG, Lutz DA. Turnover TRAM flap as a diaphragmatic patch. Ann Plast Surg 2004; 52 (01) 93-96
- 3 Watanabe T, Matsumoto H, Yoshida R, Yasui K, Yagi T, Kimata Y. Pectoralis major and serratus anterior muscle flap for diaphragmatic reconstruction. Ann Thorac Surg 2022; 114 (01) e51-e54
- 4 Abboud NM, Rimbault M, Abboud S, El Nakadi I, Charara FG. A surgical alternative in the treatment of recurrent diaphragmatic hernia after total gastrectomy. Plast Reconstr Surg Glob Open 2020; 8 (12) e3302
- 5 Vigneswaran Y, Bryan AF, Ruhle B, Gottlieb LJ, Alverdy J. Autologous posterior rectus sheath as a vascularized onlay flap: a novel approach to hiatal hernia repair. J Gastrointest Surg 2022; 26 (01) 268-274
- 6 Santillan-Doherty P, Jasso-Victoria R, Sotres-Vega A. et al. Thoracoabdominal wall repair with glutaraldehyde-preserved bovine pericardium. J Invest Surg 1996; 9 (01) 45-55
- 7 Yamashita T, Asai K, Suzuki K. Reconstructed diaphragm by fascia lata: 13 years in vivo. Ann Thorac Surg 2021; 111 (04) e247-e248
- 8 Suzuki K, Takahashi T, Itou Y, Asai K, Shimota H, Kazui T. Reconstruction of diaphragm using autologous fascia lata: an experimental study in dogs. Ann Thorac Surg 2002; 74 (01) 209-212
- 9 Kageyama Y, Suzuki K, Matsushita K, Takahashi T, Kazui T. Diaphragm reconstruction with autologous fascia lata: report of a case. Surg Today 1999; 29 (12) 1285-1286
- 10 Bedini AV, Andreani SM, Muscolino G. Latissimus dorsi reverse flap to substitute the diaphragm after extrapleural pneumonectomy. Ann Thorac Surg 2000; 69 (04) 986-988
- 11 Nakanishi R, Nishikawa H, Nagata S. Diaphragm reconstruction after extrapleural pneumonectomy [in Japanese]. Kyobu Geka 2004; 57 (11) 1050-1053
- 12 Cormack GC, Lamberty BGH. The arterial anatomy of skin flaps. 2nd ed. 282 × 222 mm. Pp. 538. Illustrated. 1994. Edinburgh: Churchill Livingstone. £179. Br J Surg 1995; 82 (09) 1291
- 13 Dinner MI, Dowden RV. The value of the anterior rectus sheath in the transverse abdominal island flap. Plast Reconstr Surg 1983; 72 (05) 724-726