Comprehensive surgical management of the paralyzed diaphragm
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The document discusses various surgical techniques for managing paralysis of the diaphragm, including nerve transfers, nerve grafts, and electrical stimulation of the phrenic nerve (diaphragm pacing). It provides details on anatomy and causes of diaphragm paralysis, as well as outcomes of different procedures. Recent research has found that nerve grafts can successfully reinnervate the diaphragm in some patients with unilateral paralysis, improving quality of life and lung function.
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Congenital diaphragmatic hernia (CDH) is a birth defect that affects about 1 in 2,000-5,000 live births. It occurs when the diaphragm fails to fully form, allowing abdominal organs to migrate into the chest cavity and compress lung development. Untreated CDH has a high mortality rate of nearly 70%. Prenatal diagnosis by ultrasound is possible as early as the second trimester. Postnatal treatment may involve mechanical ventilation, nitric oxide, surfactant therapy, and in severe cases, extracorporeal membrane oxygenation (ECMO) or surgery to repair the diaphragmatic defect. Long-term outcomes include risks of chronic lung disease, feeding difficulties, growth
Congenital diaphragmatic hernia
Congenital diaphragmatic hernia is a neonatal emergency that occurs when abdominal organs push into the chest cavity through a defect in the diaphragm. It has traditionally had high mortality rates, but preoperative stabilization techniques including nitric oxide, high frequency ventilation, ECMO, and permissive hypercapnia have reduced mortality to under 75%. The presentation depends on when during fetal development the hernia occurred. Treatment involves preoperative stabilization followed by surgical repair once stabilized, with postoperative care focused on managing pulmonary hypertension and hypoplasia. Prognosis depends on the degree of lung and heart hypoplasia and presence of other defects.
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Comprehensive surgical management of the paralyzed diaphragm
- 1. Comprehensive Surgical Management of the Paralyzed Diaphragm Matthew R. Kaufman, MD, FACS Plastic & Reconstructive Surgery The Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 2. Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 6. Phrenic Nerve Anatomy Accessory Phrenic Nerve Accessory Phrenic Nerve Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 24. Diaphragm Pacemaker Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 25. Diaphragm Pacemaker Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 26. Diaphragm Pacemaker Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 27. Diaphragm Pacemaker Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 28. Diaphragm Pacemaker Avery Biolabs Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 35. Diaphragm Paralysis Neurotization Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 36. Diaphragm Paralysis Neurotization Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 38. Diaphragm Paralysis Spinal Accessory Nerve Brainstem Spinal Cord Dual Origins Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 43. Unilateral Diaphragm Paralysis Phrenic Nerve Injury Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 44. Phrenic Nerve Grafting Nerve Interposition Graft or Nerve “Bypass” Neck Chest Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 45. Phrenic Nerve Grafting Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 46. Phrenic Nerve Grafting Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 51. Diaphragm Re-Innervation Quality of Life Improvements Normal function = 100
- 52. Diaphragm Re-Innervation Improvements in PFTs
- 53. Diaphragm Re-Innervation Phrenic Nerve Grafting Return of Diaphragmatic Function 10 months following grafting Center for Treatment of Paralysis and Reconstructive Nerve Surgery
- 56. Thank You! Center for Treatment of Paralysis and Reconstructive Nerve Surgery