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.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Shamberger RC. Chest wall deformities. In: Shields TW, editor. General thoracic surgery. Malvern: Williams & Wilkins; 1994. p. 529–57.
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.
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.
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.
Welch KJ. Chest wall deformities. In: Holder TH, Ashcraft K, editors. Pediatric surgery. Philadelphia: WB Saunders Company; 1980. p. 162–82.
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.
O’Neal M, Dwornik J, Ganey T, et al. Postnatal development of the human sternum. J Pediatric Orthop. 1998;18:398–405.
Kotzot D, Huk W, Pfeiffer R. Genetic counseling of cleft sternum. Genet Couns. 1994;5:147–50.
Acastello E, Majluf R, Garrido P, Barbosa LM, Peredo A. Sternal cleft: a surgical opportunity. J Pediatr Surg. 2003;38:178–83.
Samarrai AR, Charmolockly AM, Attra AA. Complete cleft sternum: classification and surgical repair. Int Surg. 1985;70:71–3.
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.
Ravitch MM. Congenital deformities of the chest wall and their operative correction. Philadelphia: Saunders; 1977. p. 23–5.
Lannelongue M. De le´ctocardie et de sa cure par autoplasie. Ann Med Chir. 1888;4:101.
Burton J. Method of correction of ectopia cordis. Arch Surg. 1947;54:79–84.
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.
Sabiston DC. The surgical management of congenital bifid sternum with partial ectopia cordis. J Thorac Surg. 1958;35:118–22.
Meissner F. Fissura sterni congenita. Zentralbl Chir. 1964;89:1832–9.
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.
Daoud S, Jacob Y, Lefort G, et al. Correction de la bifide sternale par une prothese en silastic. Chir Pediat. 1964;21:415–7.
Greenberg BM, Becker JM, Pletcher BA. Congenital bifid sternum: repair in early infancy and literature review. Plast Reconstr Surg. 1991;88:886–9.
Shamberger R, Welch K. Sternal defects. Pediatr Surg Int. 1990;5:154–64.
Knox L, Tuggle D, Knoxtt-Craig CJ. Repair of congenital sternal cleft in adolescence and infancy. J Pediatr Surg. 1994;29:1513–6.
Hebra A, Davidoff A, O’Neill J. Neonatal sternal cleft associated with an extrathoracic cystic mass. J Pediatric Surg. 1997;32:627–30.
Yavuzer S, Kara M. Primary repair of a sternal cleft in an infant with autogenous tissues. Interact CardioVasc Thorac Surg. 2003;2:541–3.
Hazari A, Mercer N, Pawade A, et al. Superior sternal cleft: construction with a titanium plate. Plast Reconstruct Surg. 1998;101:167–70.
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.
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.
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.
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.
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.
• 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.
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.
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.
• 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.
• 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.
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.
Snyder BJ, Robbins RC, Ramos D. Primary repair of complete sternal cleft with pectoralis major muscle flaps. Ann Thorac Surg. 1996;61:983–4.
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.
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Korkut Bostanci and Davor Stamenovic declare that they have no conflicts of interest.
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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
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DOI: https://doi.org/10.1007/s40137-018-0205-x