Primary Closure of a Subtotal Sternal Cleft in a 7-Day-Old Neonate

Keywords: chest, chest wall, sternum, wound healing

Abstract

Sternal cleft is a rare congenital abnormality that results from incomplete fusion of the two lateral mesodermal sternal bars. It is generally accepted that primary repair in the neonatal period is the best treatment option. However, significant distance between the sternal bars can be challenging because of cardiac compression.

The aim. We report a case of a 7-day-old neonate with a subtotal sternal cleft successfully managed by direct closure.

Material and methods. A full-term male neonate weighing 3 kg was referred to our clinic for evaluation of a chest wall defect. The chest X-ray and computed tomography were performed to evaluate the malformation.

Results. Surgery was performed at the age of 7 days. Postoperative period was uneventful. The patient was discharged on the postoperative day 21. The first postoperative checkup after 3 months showed satisfactory cosmetic results and normal respiratory movements.

Conclusion. Despite the significant diastasis between sternal bars, primary direct closure of the sternal cleft can be safely performed in neonates.

References

  1. Ates MS, Duvan I, Onuk BE, Kurtoglu M. Isolated Sternal Cleft in a Patient With Coronary Artery Disease. World J Pediatr Congenit Heart Surg. 2016 Mar;7(2):238-40. https://doi.org/10.1177/2150135115589790
  2. Fokin AA, Steuerwald N, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;21(1):44-57. https://doi.org/10.1053/j.semtcvs.2009.03.001
  3. Torre M, Rapuzzi G, Carlucci M, Pio L, Jasonni V. Phenotypic spectrum and management of sternal cleft: literature review and presentation of a new series. Eur J Cardiothorac Surg. 2012;41(1):4-9. https://doi.org/10.1016/j.ejcts.2011.05.049
  4. Yavuzer S, Kara M. Primary repair of a sternal cleft in an infant with autogenous tissues. Interact Cardiovasc Thorac Surg. 2003 Dec;2(4):541-3. https://doi.org/10.1016/S1569-9293(03)00127-0
  5. Semlacher RA, Nuri MAK. Successful management of absent sternum in an infant using porcine acellular dermal matrix. Arch Plast Surg. 2019 Apr 11;46(5):470-474. https://doi.org/10.5999/aps.2018.00829
  6. Ballouhey Q, Armendariz M, Vacquerie V, Marcheix PS, Berenguer D, Mouliès D, Fourcade L. Primary repair of sternal cleft with a double osteochondroplasty flap. Interact Cardiovasc Thorac Surg. 2013;17(6):1036-7. https://doi.org/10.1093/icvts/ivt380
  7. Baqain EB, Lataifeh IM, Khriesat WM, Fraiwan NM, Armooti MA. Primary repair of a large incomplete sternal cleft in an asymptomatic infant with Prolene mesh. J Pediatr Surg. 2008 Oct;43(10):e39-41. https://doi.org/10.1016/j.jpedsurg.2008.05.036
  8. Smith AEP, Mani A, Jones A, Jordan SJ. Surgical repair of complete congenital sternal cleft associated with pectus excavatum. The Annals of Thoracic Surgery. 2020;109(1):e51-e53. https://doi.org/10.1016/j.athoracsur.2019.04.079
  9. Al-Yamani M, Lavrand F, Thambo JB, Roubertie F. Upper sternal cleft with a complex congenital heart defect: repair in a single stage. Ann Thorac Surg. 2016;101(2):760-2. https://doi.org/10.1016/j.athoracsur.2015.03.049
  10. Dumitrescu A, Ryan CA, Green A. Sternal cleft malformation in a newborn. BMJ Case Rep. 2017;2017:bcr2017220237. https://doi.org/10.1136/bcr-2017-220237
Published
2021-03-16
How to Cite
Sekelyk, R., Kozhokar, D., Yusifli, I., Tammo, R., & Yemets, I. (2021). Primary Closure of a Subtotal Sternal Cleft in a 7-Day-Old Neonate. Ukrainian Journal of Cardiovascular Surgery, (1 (42), 60-63. https://doi.org/10.30702/ujcvs/21.4203/s003060-063/089.21