The cleft sternum: a possible role for pliable prosthetic reconstruction.

BACKGROUND: Faced with our intraoperative inability to primarily close a very wide isolated cleft sternum of a pediatric patient without causing cardiovascular decompensation, we describe our use of a synthetic material for partial approximation allowing muscular coverage. METHOD: We report an infant who was born with an isolated large complete sternal cleft where a trial of primary surgical repair had to be abandoned because of cardiovascular compromise. A similar difficulty was encountered in approximating the origins of both pectoralis major muscle flaps at the midline. Thus, a pliable synthetic patch was helpful in partially obliterating the widened sternal defect allowing successful muscular coverage. RESULT: Closure of a wide congenital sternal cleft using a synthetic material that partially obliterated an otherwise widely separated cleft sternum which was neither amenable for primary repair, nor by bilateral pectoralis major advancement alone, was possible. CONCLUSION: Strong prosthetic pliable material may offer a simple and useful procedure allowing obliteration of the widely separated cleft sternum not amenable for primary repair.