Staged Cleft Sternum Repair Using Dermal Allograft and Synthetic Mesh

Abstract

Cleft sternum is a rare congenital chest deformity that develops during the first trimester. Failure of the process of midline mesenchymal strip fusion leads to absence of the sternum, resulting in cleft formation. Multiple surgical approaches have been described in the closure of sternal clefts. An optimal surgical approach is still debatable. We describe 2 cases of complete sternal clefting treated with staging of the repair. Dermal allograft and synthetic mesh along with myofasciocutaneous flaps are used a bridging method to future definitive treatment. Most patients will require secondary cardiothoracic procedures for underlying cardiac conditions, and disruption of any primary repair is compromised on reentry into the chest. Staging this procedure avoids this potential problem. Also, concerns regarding chest wall constriction and cardiopulmonary compromise are minimized. Once the child has matured, definitive treatment can be pursued with more abundant autologous donor tissue. Our approach is safe with minimal complications and is well tolerated by the patients.

An innovative method of pediatric chest wall reconstruction using Surgisis and swinging rib technique

“…Multiple approaches to sternal cleft repair have been described, most of which used a single-stage technique, and some included the use of different types of mesh [13,14]. One recent case series reported staged sternal cleft closure in 2 infants, which included the use of an absorbable plate (Synthes Inc, West Chester, PA, USA) in the first step and an ultrathick dermal allograft (Synthes Inc, West Chester, PA, USA) 3 years later in addition to a Goretex mesh [15]. In the context of cardiac comorbidities, the use of Goretex may be reasonable because repeated cardiac interventions will be required, allowing removal or replacement of the nonabsorbable material.…”

Congenital Superior Sternal Cleft Isolated in a Newborn: Report of a Rare Case and a Literature Review

“…In older patients, the chest cavity is stiff and difficult to repair. Sliding chondrotomy and clavicle dislocation are effective and beneficial in elderly patients with chest wall stiffness because they increase chest wall compliance [ 19 , 20 ]. Partial or complete thymectomy is also sometimes required to reduce the risk of mediastinal compression during closure.…”

Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review

“…Both patients tolerated the procedure well, with seroma formation during subsequent follow-ups. 14 We have used a similar approach after an intraoperative trial that showed difficulty in harvesting an autologous rib graft affecting chest wall stability as discussed with the interdisciplinary team. Dermal matrix graft of higher mechanical properties (SurgiMend, Integra LifeSciences Inc.) was then utilized as a means to stabilize the cleft margin in 1 of the patients.…”

“… 3 , 11 , 12 The use of different prosthetic as well as biologic mesh grafts was also utilized to aid in the closure of such defects with variable outcomes. 13 , 14 …”