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A Novel Use of the Resorb x® Plating System in Pediatric Chest Wall Reconstruction
DeAsia Jacob, MD
Rachel Aliotta, MD
Neil Kundu, MD
David Magnuson, MD
Francis Papay, MD
Cleveland Clinic Foundation
2018-01-30
Presenter: DeAsia Jacob, MD
Affidavit:
This abstract is the original work of the resident and has not been presented at any major meeting or in any scientific journal
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Congenital diaphragmatic hernia (CDH) is an infrequent occurrence but can present a complex situation for obstetricians, pediatricians, surgeons and patient's families after birth. The respiratory system can be affected from very minimal conservative measures to manage the airway, to extracorporeal membrane oxygenation to sustain life in severely affected patients. Primary closure often is not feasible and many autologous tissue, prosthetic and biosynthetic options exist to assist with closure. Many of the sequelae of this repair manifest later in childhood with revision being common for many reasons, most commonly for reherniation.
A 7-month old infant who underwent CDH repair in the first week of life presented to a plastic surgeon with right chest wall depression inconsistent with the commonly seen post-thoracotomy scoliosis or pectus deformity. A trial of conservative management failed as serial imaging over the course of 7 years showed no improvement in the deformity. As the patient aged, her and her family became more dissatisfied with the noticeable chest wall defect. At 7 years after the initial CDH repair, chest wall reconstruction was successfully performed using a poly (D,L-lactide) acid plating system commonly used in craniomaxillofacial surgery. Intraoperative findings were significant for strangulation of the rib growth centers likely leading to the uncommon chest wall deformity. This case illustrates a unique approach to primary pediatric chest wall reconstruction after arrest of chest wall growth secondary to primary CDH repair and also highlights the importance of correct surgical technique in pediatric patients, especially when operating near bone growth centers.
