Abstract:
A novel surgical procedure directed to improvement of the diaphramatic muscle function is described. This is accomplished by isolation of the latissimus dorsi muscle and relocation to the plural cavity. The latissimus dorsi muscle is then sutured to the diaphragm followed by synchronous stimulation with the patient&#39;s respiration.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application claims priority based on U.S. provisional application Ser. No. 60/120,830, filed Feb. 19, 1999. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention relates to a medical procedure for augmenting diaphramatic function. In a healthy person the diaphragm elevates to compress the avioli and distends as the lungs fill with air during an inhalation event. Such diaphramatic function can be hindered for several reasons, including chronic pulmonary obstructive disease, spinal cord injury, diaphramatic muscle dysfunction and paralysis of the diaphragm. For example, chronic pulmonary obstructive disease is a common medical problem associated with an over inflated lung, destruction of the avioli and atrophied diaphramatic muscle. It has been estimated that more than 20 million people suffer from this condition. 
     Current treatments for chronic pulmonary obstruction disease are based on medical and surgical approaches. Medical approaches generally entail breathing with an inhaler while conventional surgical procedures include lung reduction. These have not improved the outcome and the latter surgical procedures are generally associated with a high incidence of failure. Therefore, the present surgical procedure is an alternate approach which relates to muscle reinforcement of a flattened and weakened diaphragm to provide improved respiration function in patients with impaired diaphramatic function. 
     SUMMARY OF THE INVENTION 
     The present invention is a novel surgical procedure directed to improvement of the diaphramatic muscle function. This is accomplished by myoplasty of the diaphramatic muscle and synchronous stimulation with the patient&#39;s respiration. The operation is performed as an isolated procedure or in conjunction with a lung reduction operation procedure. After anesthesia and routine preparation, the chest wall muscle is isolated. It is important to preserve the nerve supply for the isolated muscle. The chest wall muscle is brought into the plural cavity and sutured to the diaphragm. Leads from a nerve stimulator are sutured to the nerve supply of the muscle. The transplanted muscle is then stimulated in synchrony with respiration and diaphramatic motion. 
     The present surgical procedure benefits patients with relatively high pulmonary volume and marked atrophied diaphragm, such as those suffering from chronic obstructive pulmonary disease. These people lack proper diaphramatic function, which conventional medical and surgical approaches have not been entirely successful in restoring. 
    
    
     These and other concepts will become more apparent to those skilled in the art by reference to the following description and the appended drawing. 
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a perspective view of the rib cage and a diaphramatic myoplasty procedure according to the present invention. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Turning now to the drawing, a diaphramatic myoplasty procedure according to the present invitation will be described in detail. FIG. 1 shows a skeletal representation of the human rib cage  10  including selected portions of the soft tissue. The present surgical procedure begins with routine surgical preparation. Following general anaesthetic and endotrachial intubation, a limited transauxiliary incision is made over the fifth intercostal space  12 . The skin and subcutaneous tissues are incised. With careful sharp and blunt dissection, the right latissimus dorsi muscle  14  is identified and separated from the surrounding muscles. Next, the right latissimus dorsi muscle  14  is divided from its insertion into the iliac crest  16 . The right latissimus dorsi muscle  14  is elevated, and the thoraco dorsal nerve and the artery of the latissimus dorsi muscle are then identified and preserved. A thorocotomy is now performed through the second  18  and seventh  20  intercostal space. 
     Next, the unipolar lead  22  of a neurostimulator  24  is passed perpendicular to the neurovascular bundle, close to the insertion of the right latissimus dorsi muscle to the humeral bone (not shown). A suitable neurostimulator can be purchased from Medtronic, Inc. of Minneapolis, Minn. under the TRANSFORM® label. After satisfactory threshold measurement, the lead  22  is connected to the stimulator and buried under the skin of the chest wall. The right latissimus dorsi muscle  14  is passed through the second intercostal space  18  and retrieved in the seventh intercostal space  20 . The right latissimus dorsi muscle  14  is sutured to the dome  26  of the right diaphragm  28  using interrupted sutures  30  followed by continuous sutures. After satisfactory muscle contraction in synchrony with respiration is established by activation of the neurostimulator  24 , the thorocotomy and skin incisions are closed. 
     Contraction of the relocated right latissimus dorsi muscle  14  compresses the overextended avioli (not shown) by upward motion of the diaphragm  28 . In that manner, the present diaphramatic myoplasty procedure restores the over distended air space to its normal size. 
     In FIG. 1, the right latissimus dorsi muscle is shown sutured to the right portion of the diaphragm. The diaphragm is generally divided into a right portion and a left portion, delineated by the heart. This is sufficient for compressing the right lung, but may not necessarily benefit compression of the left avioli. Therefore, the above described procedure is repeated for the left diaphragm. Alternatively, a length of tendon, synthetic muscle  32  or suitable prosthetic material is sutured to the right latissimus dorsi muscle  14  adjacent to the third intercostal space  34  and the left dome  36  of the diaphragm  28  proximate the sixth intercoastal space  38  of the left portion  40  of the rib cage  10 . That way, as the right latissimus dorsi muscle  14  contracts, the synthetic muscle  32  is elevated to compress the left avioli. Relaxation of the right latissimus dorsi muscle  14  results in the synthetic muscle  32  decreasing in elevation to allow for an inhalation event. 
     Other muscles of the human body that are useful for augmenting diaphramatic function according to the present invention include the pectoralis major and the rectus adominus. Adaptation of the present procedure to use of these alternate muscles will be readily understood by those skilled in the art. 
     The present diaphramatic myoplasty procedure is a novel concept which allows a fibrillated, weak diaphragm muscle to move upward and empty over distended avioli. This novel approach is not only beneficial for thousands of chronic obstructive pulmonary disease cases, but also for patients with spinal cord injury and diaphramatic muscle dysfunction. 
     It is appreciated that various modifications to the invention concepts described herein may be apparent to those skilled in the art without departing from the spirit and scope of the present invention defined by the hereinafter appended claims.