Diaphragmatic paralysis managed by diaphragmatic replacement

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Biomaterials in Medicine

Background:

• Neonatal diaphragmatic paralysis can result from brachial plexus birth trauma, leading to persistent ventilatory impairment.
• Conventional diaphragmatic plication is a surgical approach to correct diaphragmatic dysfunction but may not always be successful.

Observation:

• A neonate with right hemidiaphragm paralysis, secondary to birth trauma, remained ventilator-dependent despite two failed diaphragmatic plication surgeries.
• Paradoxical diaphragmatic motion and detrimental infantile mediastinal shifts were observed.

Findings:

• Total replacement of the paralyzed right hemidiaphragm with Marlex mesh successfully corrected ventilatory insufficiency.
• The prosthetic repair eliminated paradoxical motion and stabilized the mediastinum, with no major prosthesis-related growth deformity observed at 3.5 years.

Implications:

• Marlex mesh diaphragmatic prostheses offer a viable, long-lasting solution for refractory neonatal diaphragmatic paralysis.
• This prosthetic approach should be considered when conventional diaphragmatic plication fails in pediatric patients.
• Early and effective management of diaphragmatic paralysis is crucial for preventing long-term respiratory compromise and developmental issues.