Background: The use of a vascularized pedicle flap of diaphragmatic muscle (DF) for
reconstructive procedures in the chest has many advantages. Yet, despite the
excellent reported results, the use of DF has not been widespread. Some factors for the less
widespread use of DF have been, concern about diaphragmatic function,
hesitation to use such a vital muscle for reconstructive purposes, and most
importantly, the technical aspects for the preparation of the flap. Methods: Using a cadaveric model, the vascular anatomy of the diaphragm and the steps
for the preparation of the DFwas
defined and illustrated for both the right and left hemidiaphragm. Results: No perioperative mortality with the use of DF has been recorded. Function of the native diaphragm has not been impaired.
Bronchopleural fistulas and pericardial defects have healed in all instances.
Excellent repair has been achieved in all patients with esophageal lesions. The
disruption of the repaired native diaphragm and visceral herniation has been
reported but it has been attributed to the learning curve and the technique of
repair. Conclusion: With a better understanding of the vascular anatomy
of the diaphragm and a formal methodical approach to harvesting the DF, more
surgeons will be encouraged to use DF with excellent results.
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