So, here it is, a little more info on Owain's latest and greatest surgery. For any of you that are among the CDH community looking for some good solid info on the different methods used to repair a herniated diaphragm, Owain's story is full of options! His first surgery, surgeons used a patch of goretex to fill the void of his diaphragm. While we had hopes that he had some diaphragm to sew together, Owain had almost a non existing left diaphragm. So much to the fact that on his posterior, there was not even a fringe of diaphragm growth to work with. This set the stage for the following 3 surgeries.
Each time, Owian's own growth was a factor in each surgery. Goretex is not a material that grows or stretches, so Owain's body growth is what was to blame for all his re-herniations(aside from his 3rd which ended up being near his trachea and was then plugged with goretex 2 days after his 2nd surgery). During this most recent surgery, Owain was a trooper the whole 7-8 hours(?!). Every 2 hours we received a call stating that "Owain is stable" and there was "Little blood loss". This was exciting news especially since the surgery was scheduled to be only 4.5 hours long.
So what made a 4.5 hour surgery take so long? Well I am not sure if you have read any free medical journals on CDH, but there is an issue that is common called adhesion. 'What is adhesion?' you ask and how does it pertain to CDH? Adhesion is adhesion in the root sense of the word, adhesion is a term used in reference to the large intestine mostly. After being shifted around and then settling, tiny cell structures start growing anchoring the intestines in place, adhering them to goretex, themselves, the abdominal cavity wall, and so on and so fourth. This made it difficult for the surgeons to expose the area they worked with before. So very painstakingly they got everything out of the way so they could start the MEAT of the surgery.
ENTER LATTISSIMUS DORSI
For this surgery, we were expecting on the surgeons using the same thing as last time(goretex) with the addition of a new material called Alloderm which is a human derived cellular lattice which allows excellent tissue integration. We then read about
Sofia Miller having a muscle flap used as a replacement for the diaphragm, which we inquired about. Sure enough after asking our surgeon about it, he brought in a plastic surgeon to consult with us.
The goal of this operation, was to completely cover Owain's defect with is lattisimus dorsi muscle. Sure he will be missing a muscle, but the benefit of not having a surgery for a really long time makes definitely advantageous for him. They also were aiming to attach the main nerve supply that is usually connected to the thoracodorsal to the phrenic nerve that controls the diaphragm. Unfortunately they were unable to make the connection since they could not find the phrenic nerve. Instead they tunneld the nerve ending through the right diaphragm in hopes that electrical signals would eventually be received by the main lattissimus node. This type of nervous integration might take up to a year.
They also used AlloDerm as a buttress to the muscle itself to keep it from tearing. They also left all the other repairs in place as well. So Owain has a literal repair sandwich for a diaphragm. Goretex on the bottom(Which tissue integrated extremely well we heard), AlloDerm in the middle, and lattissimus on the top.
We are all glad that Owain now has a diaphragm that will grow with him. What a trooper.
