Primary repair of sternal cleft in infancy using combined periosteal flap and sliding osteochondroplasty

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.

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Primary repair of complete sternal cleft associated with absent anterior pericardium

Journal of Cardiac Surgery ◽

10.1111/jocs.13132 ◽

2017 ◽

Vol 32 (5) ◽

pp. 316-317

Author(s):

Amr A. Arafat ◽

Ayman A. Sallam ◽

Amr A. Abdelwahab ◽

Abdel-Hady M. Taha

Keyword(s):

Primary Repair ◽

Sternal Cleft

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Primary repair of complete sternal cleft with pectoralis major muscle flaps

The Annals of Thoracic Surgery ◽

10.1016/0003-4975(95)00786-5 ◽

1996 ◽

Vol 61 (3) ◽

pp. 983-984 ◽

Cited By ~ 21

Author(s):

Brett J. Snyder ◽

Robert C. Robbins ◽

Douglas Ramos

Keyword(s):

Primary Repair ◽

Pectoralis Major Muscle ◽

Pectoralis Major ◽

Muscle Flaps ◽

Sternal Cleft

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Cleft Palate Repair Using a Marginal Musculo-Mucosal Flap

The Cleft Palate-Craniofacial Journal ◽

10.1597/05-011 ◽

2006 ◽

Vol 43 (6) ◽

pp. 651-655 ◽

Cited By ~ 9

Author(s):

Hisao Ogata ◽

Tatsuo Nakajima ◽

Fumio Onishi ◽

Ikkei Tamada ◽

Makoto Hikosaka

Keyword(s):

Cleft Palate ◽

Soft Palate ◽

Hard Palate ◽

Primary Repair ◽

Formation Rate ◽

Fistula Formation ◽

Mucosal Flap ◽

Periosteal Flap ◽

Oronasal Fistula ◽

Palate Repair

Objective: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. Methods: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. Results: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. Conclusions: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non–push-back method of hard palate repair.

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Primary Repair is Possible in Complete Sternal Cleft: The First Saudi Experience

Journal of King Abdulaziz University-Medical Sciences ◽

10.4197/med.17-2.6 ◽

2010 ◽

Vol 17 (2) ◽

pp. 75-80

Author(s):

Husain Jabbad

Keyword(s):

Primary Repair ◽

Sternal Cleft

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Primary closure of superior partial sternal cleft in a 2-month-old girl: case report

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00113-8 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Halil Ibrahim Tanriverdi ◽

Fulya Doğaneroğlu ◽

Abdülkadir Genç ◽

Ömer Yılmaz

Keyword(s):

Case Report ◽

Primary Repair ◽

Three Dimensional ◽

Early Period ◽

Ventilator Support ◽

Case Presentation ◽

Sternal Cleft ◽

Cardiac Compression ◽

Rare Malformation ◽

Respiratory Movements

Abstract Background Sternal cleft is a quite rare malformation. It is seen 1 out of 100,000 live births and makes up less than 1% of all chest wall deformities, seen more often among females. The deformity can be partial or complete. Partial deformities can be superior or inferior. It is generally diagnosed at birth when paradoxical respiratory movements are seen. Patients are often asymptomatic when they are born and generally other abnormalities accompany. As sternal clefts can be repaired primarily at early ages, they are repaired using autologous or synthetic grafts in the following years. We present a 2-month-old girl with superior partial sternal cleft repaired primary and accompanying hemangiomas in this case report. Case presentation A girl who was born in another center and had a sternal cleft, who did not have any problems in the early period, was admitted to our hospital with respiratory distress at the age of 43 days. The patient was monitored with mechanical ventilator support, and there were hemangiomas around his left ear and lips. There were paradoxical respiratory movements in front of the heart, in the upper midline of the chest. Three-dimensional computed tomography showed that the upper part of the sternum did not develop, and there were hypoplasic sternal bars on both sides. It was evaluated as superior partial sternal cleft, and surgery was planned. In the operation, the sternal bars were released from the pericardium and pleura. The periosteum in the medial of both sternal bars was then released and connected in the midline, in front of the pericardium. Conclusion Although neonates with a sternal cleft are asymptomatic at birth, respiratory symptoms may develop in later periods. In addition, because the structures are more flexible in the neonatal period, the primary repair of the cleft is easier and the risk of cardiac compression is lower. In our case, sternal bars could be approached primary, and no chondral grafts, patches, or steel wires were required.

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STERNAL CLEFT AND SEGMENTAL FACIAL HEMANGIOMAS IN CHILDREN WITH PHACES SYNDROME: EFFECTIVENESS AND SAFETY OF CONSERVATIVE MANAGEMENT AND SURGICAL CORRECTION

Wiadomości Lekarskie ◽

10.36740/wlek202006137 ◽

2020 ◽

Vol 73 (6) ◽

pp. 1267-1271

Author(s):

Iryna M. Benzar ◽

Anatolii F. Levytskyi ◽

Vlasii M. Pylypko

Keyword(s):

Risk Factors ◽

Primary Repair ◽

Cardiovascular Complications ◽

Partial Resection ◽

Surgical Correction ◽

Phaces Syndrome ◽

Sternal Cleft ◽

Hemorrhagic Complications ◽

Propranolol Treatment ◽

Propranolol Therapy

The aim is to determine the risk factors of sternal cleft and segmental facial hemangiomas association in children with PHACES syndrome. Materials and methods: 32 inpatient children with segmental facial hemangiomas and 19 children with sternal cleft were investigated concerning the Metry criteria of PHACES syndrome. Results: In 6 children PHACE syndrome was diagnosed. Patients with bilateral S3 hemangiomas (50%, 3/6) had airway involvement with respiratory disorders. Conservative treatment was propranolol monotherapy (66.7%, 4/6), or combination of prednisolone and propranolol (33.3%, 2/6). Duration of propranolol treatment in children with PHACES syndrome was on an average 24.25 � 4.49 months exceeding the duration of propranolol therapy in children with isolated soft tissue lesions (p<0.05). Primary surgical treatment of sternal cleft performed in children aged 2 (n=3) and 4 (n=1) months. The later period of surgery associated with the localization of hemangioma in the surgery region. Primary repair of sternal cleft was completed successfully in all cases; partial resection of the thymus made closure easier. Conclusions: Primary surgical correction of a sternal cleft performed in young children provides good results. Partial resection of the thymus prevents respiratory and cardiovascular complications. Preoperative propranolol treatment averts the hemorrhagic complications in children with hemangiomas in surgical region.

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