Pericardial repair after extensive resection: Another use for the pedicled diaphragmatic flap

Background. Extended resection for pulmonary malignancy frequently leaves a large pericardial defect, sometimes associated with resection of the phrenic nerve. On the left the defect does not require repair; as long as the defect is sufficiently large to avoid constriction, the heart can herniate freely. On the right such herniation is associated with venous inflow occlusion and death. The pedicled diaphragmatic flap has been used in other situations in thoracic surgery. We have modified this to allow closure of the pericardial defect and concurrent plication of the denervated diaphragm. It may also be used to cover the bronchial stump or a bronchial anastomosis. Methods. The flap has been used in 13 patients over an 11-year period. Results. Secure closure of the pericardial defect has been achieved in all patients with satisfactory plication of the diaphragm. Reoperation for bleeding was necessary in 3 patients, but in only 1 was the diaphragm shown to be the site of bleeding. Patients otherwise made an uneventful recovery. Conclusions. A large pedicled flap of redundant diaphragm provides secure closure for large pericardial defects after extended right pneumonectomy.