Skip to main content
Log in

Repair of Sternal Cleft in Children

  • Thoracic Surgery (G. Rocco and M. Scarci, Section Editors)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this paper is to review the surgical techniques for the correction of sternal cleft in children.

Recent Findings

Various surgical techniques have been developed for the correction of sternal cleft since 1949, when the first successful repair was reported.

Summary

Sternal cleft is an uncommon congenital chest wall deformity. The optimal correction can be achieved by primary repair of the defect in patients younger than 1 year of age, especially during the neonatal period, mostly with an easy technique. In older children, more extensive techniques are applied, using either autologous tissues or synthetic prosthetic materials, with satisfactory functional and aesthetic results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Shamberger RC. Chest wall deformities. In: Shields TW, editor. General thoracic surgery. Malvern: Williams & Wilkins; 1994. p. 529–57.

    Google Scholar 

  2. Fonkalsrud EW. Chest wall abnormalities. In: Baue AE, Geha AS, Hammond GL, Laks H, Naunheim KS, editors. Glenn’s thoracic and cardiovascular surgery. Stamford: Appleton & Lange; 1996. p. 581–92.

    Google Scholar 

  3. Shamberger RC, Hendren WH III. Congenital deformities. In: Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC, editors. Thoracic surgery. New York: Churchill Livingstone; 1995. p. 1189–209.

    Google Scholar 

  4. Sabiston DC Jr. Disorders of the sternum and the thoracic wall congenital deformities of the chest wall. In: Sabiston Jr DC, Spencer FC, editors. Gibbon’s surgery of the chest. Philadelphia: WB Saunders Company; 1990. p. 418–37.

    Google Scholar 

  5. Welch KJ. Chest wall deformities. In: Holder TH, Ashcraft K, editors. Pediatric surgery. Philadelphia: WB Saunders Company; 1980. p. 162–82.

    Google Scholar 

  6. Heron D, Lyonnet S, Iserin L, et al. Sternal cleft: case report and review of a series of nine patients. Am J Med Genet. 1995;59:154–6.

    Article  CAS  PubMed  Google Scholar 

  7. O’Neal M, Dwornik J, Ganey T, et al. Postnatal development of the human sternum. J Pediatric Orthop. 1998;18:398–405.

    Google Scholar 

  8. Kotzot D, Huk W, Pfeiffer R. Genetic counseling of cleft sternum. Genet Couns. 1994;5:147–50.

    CAS  PubMed  Google Scholar 

  9. Acastello E, Majluf R, Garrido P, Barbosa LM, Peredo A. Sternal cleft: a surgical opportunity. J Pediatr Surg. 2003;38:178–83.

    Article  PubMed  Google Scholar 

  10. Samarrai AR, Charmolockly AM, Attra AA. Complete cleft sternum: classification and surgical repair. Int Surg. 1985;70:71–3.

    CAS  PubMed  Google Scholar 

  11. de Campos JRM, Filomeno LT, Fernandez A, Ruiz RL, Minamoto H, de Campos Werebe E, Jatene FB. Repair of congenital sternal cleft in infants and adolescents. Ann Thorac Surg. 1998;66:1151–4.

    Article  PubMed  Google Scholar 

  12. Ravitch MM. Congenital deformities of the chest wall and their operative correction. Philadelphia: Saunders; 1977. p. 23–5.

    Google Scholar 

  13. Lannelongue M. De le´ctocardie et de sa cure par autoplasie. Ann Med Chir. 1888;4:101.

    Google Scholar 

  14. Burton J. Method of correction of ectopia cordis. Arch Surg. 1947;54:79–84.

    Article  CAS  PubMed  Google Scholar 

  15. Maier HC, Bortone F. Complete failure of sternal fusion with herniation of perdicardium. Report of a case corrected surgically in infancy. J Thorac Surg. 1949;18:851–9.

    CAS  PubMed  Google Scholar 

  16. Sabiston DC. The surgical management of congenital bifid sternum with partial ectopia cordis. J Thorac Surg. 1958;35:118–22.

    PubMed  Google Scholar 

  17. Meissner F. Fissura sterni congenita. Zentralbl Chir. 1964;89:1832–9.

    CAS  PubMed  Google Scholar 

  18. Kontiris A, Tsironis A. Bifid sternal-successful repair by use of and acrylic plaque: report of a case. J Int Col Surg. 1964;41:301–7.

    Google Scholar 

  19. Daoud S, Jacob Y, Lefort G, et al. Correction de la bifide sternale par une prothese en silastic. Chir Pediat. 1964;21:415–7.

    Google Scholar 

  20. Greenberg BM, Becker JM, Pletcher BA. Congenital bifid sternum: repair in early infancy and literature review. Plast Reconstr Surg. 1991;88:886–9.

    Article  CAS  PubMed  Google Scholar 

  21. Shamberger R, Welch K. Sternal defects. Pediatr Surg Int. 1990;5:154–64.

    Article  Google Scholar 

  22. Knox L, Tuggle D, Knoxtt-Craig CJ. Repair of congenital sternal cleft in adolescence and infancy. J Pediatr Surg. 1994;29:1513–6.

    Article  CAS  PubMed  Google Scholar 

  23. Hebra A, Davidoff A, O’Neill J. Neonatal sternal cleft associated with an extrathoracic cystic mass. J Pediatric Surg. 1997;32:627–30.

    Article  CAS  Google Scholar 

  24. Yavuzer S, Kara M. Primary repair of a sternal cleft in an infant with autogenous tissues. Interact CardioVasc Thorac Surg. 2003;2:541–3.

    Article  PubMed  Google Scholar 

  25. Hazari A, Mercer N, Pawade A, et al. Superior sternal cleft: construction with a titanium plate. Plast Reconstruct Surg. 1998;101:167–70.

    Article  CAS  Google Scholar 

  26. Muthialu N. Primary repair of sternal cleft in infancy using combined periosteal flap and sliding osteochondroplasty. Interact Cardiovasc Thorac Surg. 2013;16(6):923–5.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mathai J, Cherian VK, Chacko J, Sen S, Karl S, Pandyan MS, Mathew AK. Bridging the cleft over the throbbing heart. Ann Thorac Surg. 2006;82(6):2310–1.

    Article  PubMed  Google Scholar 

  28. de Campos JR, Das-Neves-Pereira JC, Velhote MC, Jatene FB. Twenty seven-year experience with sternal cleft repair. Eur J Cardiothorac Surg. 2009;35(3):539–41.

    Article  PubMed  Google Scholar 

  29. Chia HL, Yeow VK. Repair of inferior sternal cleft using bilateral sternal bar turnover flaps in a patient with pentalogy of cantrell. Arch Plast Surg. 2014;41(1):77–80.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. • Elsayed H, Soliman S; Reversed autogenous sternal plate flaps for treatment of sternal clefts: a novel technique. J Pediatr Surg 2015;50(11):1991–4. This article showed that reversed sternal flaps were a good option for older patients.

  32. Hill CA, Argenta LC, Hines M. Superior sternal cleft repair using autologous rib grafts in an infant with complex congenital heart disease. Ann Thorac Surg. 2007;84(2):673–4.

    Article  PubMed  Google Scholar 

  33. 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;43(10):e39–41.

    Article  PubMed  Google Scholar 

  34. • Qin T, Liu Y, An Y; Repair of inferior sternal cleft using a titanium plate in an infant with pentalogy of cantrell. J Card Surg. 2016;31(11):700–2. This article showed the advantages of titanium plates when compared to other synthetic materials used for the repair of sternal clefts.

  35. • 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 Sur. 2016;101(2):760–2. This article revealed the advantages of using an absorbable polyglactin plate for the repair of sternal clefts.

  36. Shen W, Cui J, Chen J, Zou J, Ji Y, Chen H. Reconstruction of sternal cleft and aplasia cutis with a medpor and a rectus abdominis musculocutaneous flap. J Craniofac Surg. 2012;23(1):169–71.

    Article  PubMed  Google Scholar 

  37. Snyder BJ, Robbins RC, Ramos D. Primary repair of complete sternal cleft with pectoralis major muscle flaps. Ann Thorac Surg. 1996;61:983–4.

    Article  CAS  PubMed  Google Scholar 

  38. Hochberg J, Ardenghy MF, Gustafson RA, Murray GF. Repair of thoracoabdominal ectopia cordis with myocutaneous flaps and intraoperative tissue expansion. Plast Reconstr Surg. 1995;95:148–51.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Korkut Bostanci.

Ethics declarations

Conflict of interest

Korkut Bostanci and Davor Stamenovic declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Thoracic Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bostanci, K., Stamenovic, D. Repair of Sternal Cleft in Children. Curr Surg Rep 6, 8 (2018). https://doi.org/10.1007/s40137-018-0205-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40137-018-0205-x

Keywords

Navigation