A novel use of the Resorb X® plating system in pediatric chest wall reconstruction

Abstract

Abstract Congenital diaphragmatic hernia (CDH) is an infrequent occurrence but can present a complex situation for physicians. The respiratory system can be affected in various ways. 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 non-operative management failed as serial imaging showed no improvement. As the patient aged, she 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. 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.