Reconstruction of Complete Sternal Cleft with Congenital Heart Disease

Cleft Sternum (CS) contributes to only 0.15% of all chest wall malformations. It is either complete or incomplete type. Complete CS is very rare and involves non-union of the sternal plates from the manubrium to the xiphoid. There are many methods of surgical correction. Sabiston described multiple bilateral sliding chondrotomies to approximate the defect. In our case, sternal closure was achieved by bilateral sliding chondrotomies (Sabiston’s technique) of four ribs followed by local advancement of the pectoralis major muscle flap.

We have described this technique in a different patient with Tetralogy of Fallot. [1]

The patient had Tricuspid Atresia Type IIb and underwent a standard Bidirectional Glenn shunt on cardiopulmonary bypass. The pericardium was then approximated over the heart,

Sternal reconstruction was then started. We performed bilateral sliding chondrotomies of the first four ribs and local advancement of the pectoralis major muscle to close the defect primarily with No. 2 stainless steel wires . The child was subsequently extubated uneventfully and discharged on sixth post -operative day. She is doing well on follow up.

A bony cover was achieved in a late presenter without any use of autologous or prosthetic materials. Mobilization of the pectoralis major and double-breasting provided strength to the repair and reduced the lateral tension.

This is a useful technique to treat this rare malformation.

Reference

1.Das D, Dutta N, Pandey P, Basu A, Sharma MK, Koley R, et al. Complete sternal cleft with tetralogy of Fallot. Ann Pediatr Card 2020;13:81-3.