Content uploaded by Yasser Ali Kamal
Author content
All content in this area was uploaded by Yasser Ali Kamal on Jun 11, 2018
Content may be subject to copyright.
A preview of the PDF is not available
Sternal Cleft: Appropriate Approach to Diagnosis and Treatment
Abstract
Sternal cleft (SC) is a rare congenital anomaly of the chest wall, isolated or combined with other malformations. We try to provide an appropriate stepwise approach for the diagnosis and treatment of SC. Prenatal ultrasound diagnosis can be obtained after the 18th week of gestation. At birth, diagnosis is based on the findings of clinical examination, chest x-ray, computed tomography and additional investigations for the associated anomalies. Primary approximation of the sternal bars is preferred before the age of 3 months. For older cases and rigid chest wall, the surgical correction can be achieved using prosthetic materials, autologous grafts, or biologic implants. The surgical decision depends on the age of patient, rigidity of the chest wall, and presence of other abnormalities in the chest wall.
... When the space between the costal ridges reaches the xiphoid process, the defect is V-shaped, whereas with the bony bridge joining the two edges ending at the third or fourth costal cartilage, it is U-shaped. [2][3][4] Fetal sonographic diagnosis of this defect is possible, but less practiced. It can be easily diagnosed clinically because of the presence of paradoxical chest wall movement during respiration in early infancy and due to the cosmetic deformity on the anterior chest wall. ...
... 1,2 When the defect is associated with cardiac anomaly, it seems to be more easily identifiable due to the unusual movements of the heart under the skin. [1][2][3][4]8 The decision for surgery depends on the age of the patient, rigidity of the chest wall, the size of the defect, and presence of other associated abnormalities in the chest wall and other systems. Maintaining and improving respiratory functions and cosmetic reasons are some of the indications for surgical closure. ...
... Maintaining and improving respiratory functions and cosmetic reasons are some of the indications for surgical closure. [1][2][3][4] The closure of this defect is safe in the neonatal period because the flexibility of the thorax is maximal and compression of the underlying structures is minimal. The earlier the closure is done, the better the outcome, with no or few complications. ...
Dawit Seyoum Gebremariam,1 Asmamaw Miruts,2 Kibrom Gebreselassie Desta3 1Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 2Department Surgery, Pediatric Surgery Unit, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 3Department of Surgery, Cardiothoracic Unit, College of Health Sciences, Mekelle University, Mekelle, Tigray, EthiopiaCorrespondence: Dawit Seyoum Gebremariam, Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, P.O. Box: 1871, Mekelle, Tigray, Ethiopia, Tel +251911731454, Email dgseyoum@yahoo.comAbstract: Sternal cleft is a rare chest wall anomaly resulting from a failure of the lateral mesodermal folds to migrate to the midline, causing a cleft in the early stage of embryological development. This can be a complete or partial defect. It can also occur as an isolated anomaly or in association with other syndromes. Fetal sonographic diagnosis of this defect is possible, but less practiced. After birth, this defect can be easily diagnosed clinically because of the presence of paradoxical chest wall movement. The flexibility of the thorax is maximal and compression of the underlying structures is minimal during the neonatal and early infancy period, and this period is the preferred time for surgical repair. We report a 39-day-old infant who presented with an isolated V-shaped inferior sternal cleft, its surgical primary closure, and postoperative course.Keywords: sternal cleft, surgery, congenital anomaly, complication
... Prosthetic reconstruction carries risk of extrusion, infection and lacks growth with child, contrary to autologous material. 2,3 Kabiri et al and 4 Sapiri et al 5 reported complete SC in adolescence and adults associated with pectus excavatum, where resection of the deformed cartilage for correction of pectus excavatum facilitated primary SC approximation. ...
Sternal cleft (SC) is a rare congenital malformation which can be partial or complete.
We report a case of complete SC in a 9-month-old child. Our technique involves a combination of reinforcement with the deep cervical fascial extension, followed by the anterior perichondrial flaps, bridged with the rib graft, incorporating surplus resected cartilaginous xiphoid process, and covered with the bilateral pectoralis major muscle flap for the chest wall reconstruction with 3D printing assisting preoperative planning. The size of the defect in relation to the age of presentation was a deciding factor in the adoption of this alternative surgical technique.
Sternal cleft is a rare malformation with significant morbidity and mortality. It has been associated with other midline fusion defects, most significantly Cantrell's pentalogy, involving the sternum, pericardium, heart, diaphragm, and abdominal wall. This study reported a successfully managed case of a newborn with a total sternal cleft and Cantrell's pentalogy. A review of literature and pertinent management principles was also conducted.
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.
A three day old neonate was referred to our department with a problem of a sternal cleft. Sternal clefts are often associated with a myriad of other abnormalities ranging from mild to severe. We present our experience with such a problem, and review the current literature concerning it.
Sternal cleft (SC) is a rare form of chest wall deformity with an incidence of
Congenital defects of the sternum are rare and due to a failure of midline development and fusion of the sternal bones. Surgical correction of a sternal cleft should be preferred during infancy for functional reasons. Chest wall reconstruction represented a complex problem in the last decades.
We report our successful outcome of sternal reconstruction in a rare case of PHACES syndrome, in which the patient was submitted to reconstruction of the sternum and complete closure of the thoracic defect by the employ of an extracellular matrix XCM Biologic tissue matrix.
We promote the use of extracellular matrix in surgical reconstruction of chest defects for its maneuverability, plasticity, tolerability and the possibility of growing with the children’s chest getting a good compliance and optimal cosmetic results.
Sternal cleft is a rare chest wall deformity. It can be diagnosed in the intrauterine stage with ultrasonography. Newborn period is the optimal time for the surgical correction of sternal cleft, due to the elasticity of the sternum and minimal compression of underlying structures. Here we reported a newborn patient with sternal cleft which has been operated 5 days after labor. Good surgical outcome and long-term results were accomplished.
Sternal cleft is a rare chest wall deformity associated with various malformations. Primary closure is the gold standard in the newborn period. Alternative techniques are possible for older patients. A 23-year-old woman with a partial sternal cleft and no additional deformity, underwent reconstruction using costal cartilage grafts. Postoperative physical and functional were excellent.
Sternal cleft is a rare congenital malformation. We present the case of a new-born with complete sternal cleft and skin defect, without any other associated anomaly. Operated on in the neo-natal period, the post-operative recovery was good. She developed a transitory right lateral cervical lymphangioma, which resolved spontaneously. The follow up at 4 years revealed no complications.
Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques.
Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Sternal cleft is a rare anomaly comprising 0.5% of chest wall malformations. We present a case of a neonate with a 'V'-shaped upper partial sternal cleft at birth. A hyperpigmented cutaneous nevi was present over the cleft. Primary approximation and closure of the defect was performed at 1 week of life. We discuss the presentation and management, and review the literature.