Fig. 2

Intraoperative findings. a One 2-cm and three 3-cm skin incisions were made at the fourth, sixth, eighth, and ninth intercostal spaces on the posterior axillary lines, respectively. The line marked with “IV” indicates the fourth intercostal space; “VI,” the sixth intercostal space; “VII,” the eighth intercostal space; and “IX,” the ninth intercostal space. b The latissimus dorsi muscle (LDM) was accessed and separated from the lower part to the upper along the muscle fiber, and the half of the muscle was eventually harvested as a pedicled LDM flap. c A small hole was observed at the right central tendon of the diaphragm (red arrow). d The small hole was closed with two 2-0 absorbable multifilament sutures. The central tendon around the reinforcement was covered with a sheet of absorbable polyglycolic-acid felt. e The harvested pedicled LDM flap was inserted from the ninth intercostal space of the posterior axillary line. The small hole was reinforced by the harvested pedicled LDM flap. The central tendon around the reinforcement was sprayed with fibrin glue