Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review

Abstract

Background:Sternal cleft is a rare anomaly with a reported incidence of 1:100,000 cases per live births. Surgical intervention represents a crucial factor altering the overall patient prognosis, since they are at high risk of impaired oxygenation, as well as multiple chest infections. Herein, we are reporting our experience of surgical management of such rare cases, alerting plastic surgeons to their possibly crucial role in the reconstructive team.Methods:A retrospective chart review of 2 cases presenting with chest wall defects. All perioperative data were collected and presented.Results:Two patients with sternal clefts of variable degrees were managed. The first was an 18-month-old boy with partial inferior sternal cleft, who was otherwise asymptomatic. The patient underwent reconstruction at the same age using autologous rib graft and pectoralis major flaps due to ectopia cordis that was putting the patient at higher risk for cardiac trauma. The second patient was a 3-month-old girl having a V-shaped partial superior cleft with lung herniation. Surgical reconstruction was applied due to difficulty in weaning the patient off of ventilator support. Initially, reconstruction was applied with SurgiMend dermal matrix, but this was complicated by chest retraction and high oxygen requirement. Definitive reconstruction was later applied with allogeneic bone graft and pectoralis major flaps.Conclusions:Meticulous patient assessment and screening for associated anomalies are crucial. Surgical intervention is warranted at an early age. The use of acellular dermal matrix products in the reconstruction is of interest, but should be approached with caution.

First Sternal Cleft Repair Using a Porous Alumina Ceramic Prosthesis in a 9-Year-Old Child

“…Three main surgical strategies have been described for congenital cleft closure: (1) direct closure, (2) closure using autologous tissue, or (3) artificial material. 1 5 8 9 However, no gold standard has emerges to date as the number of cases is very small.…”

“…has been described. 1 4 5 9 These techniques may lead to residual pain and exposes patients to infectious complications. Seromas have also been frequently seen.…”

“…Harvesting bone graft can be challenging and using mesh can result in a chest instability and paradoxical motion. 5…”

“…Indication of surgical closure are mainly for the protection of mediastinum and underlying organs, improvement of breathing, and to avoid recurrent respiratory infections. 5 Because of higher compliance of the thoracic cage associated to a minimal compression of underlying structures in young children, early surgery is usually preferred. 6 However, when sternal cleft closure has been delayed, the best approach for surgical treatment remains unclear.…”

“…A lot of clinical cases using various surgical technics are reported, but it is difficult to draw conclusion about the gold standard technique. 1 5…”