In most instances defects in the diaphragm can be closed by approximation of the edges with appropriate sutures. However, large defects are occasionally encountered in which this method of repair may be impossible or may result in sufficient tension on the sutures as to jeopardize sound healing. This may be the case in defects which are congenital, traumatic, or the result of necrosis following infection. En bloc resection of neoplastic disease may likewise result in large defects.
The methods previously used to repair large defects in the diaphragm can be placed in three categories: 1. Release of tension on the periphery of the diaphragm. This has been accomplished by shifting the attachment of the diaphragm upward, as described by Donovan6; by mobilizing the adjacent chest wall by thoracoplasty, as proposed by Hedblom,10 or by limited rib resection, as advocated by Bird.3 2. Use of contiguous structures, such