• D Zierold, J Perlstein, E R Weidman, and J E Wiedeman.
• Department of Surgery, David Grant Medical Center, 101 Bodin Cir, Travis Air Force Base, CA 94535, USA. dustinz@jccomp.com
• Arch Surg Chicago. 2001 Jan 1; 136 (1): 32-7.

HypothesisRecent use of minimally invasive techniques to evaluate the chest and abdomen in patients with penetrating thoracoabdominal trauma has led to the discovery of many occult diaphragm injuries. Surgical repair of these injuries is relatively straightforward. However, diagnosis can be difficult, and the natural history of these injuries is controversial. By developing a penetrating diaphragm injury model, the ultrasonographic characteristics and natural history of this injury can be better understood.SettingSurgical laboratory of a tertiary care hospital.SubjectsSeven pigs (Sus scrofa), weighing between 55 and 80 kg, received a 3-cm right-sided (n = 3) or left-sided (n = 4) diaphragm injury via thoracoscopy.InterventionsThoracoabdominal x-ray and ultrasonographic examinations were performed preoperatively; at 2, 4, 8, and 12 weeks postoperatively; and when symptoms related to the diaphragm injury occurred. At 12 weeks, or at the time of earlier death, a postmortem thoracoabdominal examination was performed.Main Outcome Measuresx-Ray and ultrasonographic characteristics, and evidence of wound healing, in a penetrating diaphragm injury model.ResultsPerioperative recovery occurred in all pigs. No pigs had radiographic evidence of immediate postoperative herniation. Pigs in the right-sided injury group died early (ConclusionsWe developed a penetrating diaphragm injury model with high and low risk of herniation. Ultrasonography may prove to be an important diagnostic adjunct in evaluating diaphragm injuries with and without herniation. Moreover, since the "protected" diaphragm injuries in our model healed spontaneously, a role may exist for the nonoperative treatment of diaphragm injuries in clinical practice. This pig model may prove useful in further defining future management and repair techniques for such injuries.

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