Reverse, innervated latissimus dorsi flap reconstruction of congenital diaphragmatic absence.

Children with congenital diaphragmatic absence have experienced a high mortality rate regardless of early intervention due to regression to fetal circulation patterns. Advances in neonatal care, particularly extracorporeal membrane oxygenation, have led to the survival of children who previously would not have lived. With growth, the Gore-Tex patch used for emergency repair in severe cases pulls away from the rib periosteum as a result of the expansile growth of the chest wall and the indistensibility of the patch. Recurrent herniation of abdominal contents ensues, slowly restricting pulmonary function and development. When pulmonary function is significantly impaired, we perform a reverse latissimus dorsi flap reconstruction with anastomosis of the thoracodorsal nerve to the phrenic nerve. Our series includes five children aged 5 to 11 months. Follow-up ranges from 22 to 50 months. Three children have proven physiologic neodiaphragmatic motion. The other two are doing well with stable absence of paradoxical motion. There have been no complications. Long-term follow-up will be required to determine their eventual fate. The prognosis is encouraging.