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Diaphragmatic flap: Technique of Preparation and Indications for Use

World Journal of Cardiovascular Surgery 2022年第9期12卷 207-218页

作者： Farid Gharagozloo Mark Meyer Institute for Advanced Thoracic Surgery University of Central Florida College of Medicine Orlando Florida USA

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 DF was 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.

关键词： Diaphragmatic flap Diaphragmatic Pedicle flap Muscle flap Bronchial Stump Reinforcement Esophageal Reinforcement vascularized flap Pedicle flap

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