Experimental validation of the original technique for plastic surgery of extensive posttraumatic diaphragm defects

Background. According to modern research studies, including those using polypropylene mesh, the recurrence rate after diaphragm plastic surgery for traumatic, congenital, and postoperative defects varies widely, ranging from 2% to 30% or more.

Aim. To evaluate the morphological and biomechanical features of the diaphragm musculo-aponeurotic structures regarding the application of an original surgical technique for treating patients with extensive post-traumatic diaphragmatic defects.

Materials and methods. An anatomical, morphological, and biomechanical study was conducted on 36 cadavers of both sexes from three age groups (young, middle-aged, and elderly) and various somatotypes. The shape and dimensions of the diaphragm and central tendon, as well as the parameters of hemomicrocirculatory network, the tensile strength, and the modulus of elasticity, were evaluated using the ISS-500 testing device. Additionally, 12 diaphragm specimens were examined after simulating an extensive defect and performing plastic surgery using an original technique. Statistical data were analysed using Statistica 10 (StatSoft, USA).

Results. Somatotype-associated variants in the shape of the diaphragm dome and central tendon were identified, gender-related differences in its dimensions (in men, the values of the sagittal and frontal dimensions were generally larger, with the maximum dimensions observed in brachymorphic and mesomorphic types). In the middle-aged and the elderly, there was a decreased density of the vascular network of the hemimicrocirculatory bed and a tendency towards the decreased tissue strength and elasticity. In the experiment, the original tension-free fixation of the mesh endoprosthesis with reinforcement of the U-shaped suture line using a frame thread resulted in a 71.95% increase in the tensile strength and a 70.41% increase in the modulus of elasticity compared to native diaphragm specimens (p< 0.05), regardless of the patients' somatotype and age.

Conclusion. Age-related and anatomical features of the diaphragm should be considered when planning reconstruction; the proposed technique strengthens the fixation line of the polypropylene mesh and improves the biomechanical reliability of plastic surgery in extensive post-traumatic defects.