Congenital absent sternum is a rare birth defect that requires early intervention for optimal long-term outcomes. Descriptions of the repair of absent sternum are limited to case reports, and no preferred method for management has been described. Herein, we describe the use of porcine acellular dermal matrix to reconstruct the sternum of an infant with sternal infection following attempted repair using synthetic mesh. The patient was a full-term male with trisomy 21, agenesis of corpus callosum, ventricular septal defect, patent ductus arteriosus, right-sided aortic arch, and congenital absence of sternum with no sternal bars. Following removal of the infected synthetic mesh, negative pressure wound therapy with instillation was used to manage the open wound and provide direct antibiotic therapy. When blood C-reactive protein levels declined to ≤2 mg/L, the sternum was reconstructed using porcine acellular dermal matrix. At 21 months postoperative, the patient demonstrated no respiratory issues. Physical examination and computed tomography imaging identified good approximation of the clavicular heads and sternal cleft and forward curvature of the ribs. This case illustrates the benefits of negative pressure wound therapy and acellular dermal matrix for the reconstruction of absent sternum in the context of infected sternal surgical site previously repaired with synthetic mesh.
Acellular Dermis ; Agenesis of Corpus Callosum ; Aorta, Thoracic ; C-Reactive Protein ; Congenital Abnormalities ; Down Syndrome ; Ductus Arteriosus, Patent ; Early Intervention (Education) ; Head ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Male ; Methods ; Negative-Pressure Wound Therapy ; Physical Examination ; Ribs ; Sternum ; Surgical Mesh ; Thoracic Surgery ; Wounds and Injuries

Sternal malunion, or loss, developed after a median sternotomy cannot only be difficult to manage and treat, but also may diminish one’s quality-of-life drastically. The technique presented here represents a multispecialty approach in one stage for the reconstruction of an unstable thoracic cage. The procedure utilized a donated sternum and ribs. The sternum with ribs harvested from a single donor included adipose derived stromal vascular fraction (ADSVF) cells with marrow also from the same donor. Autologous muscle flaps, stabilized with acellular dermal matrix were utilized to provide a robust blood supply to the ADSVF cells and bone grafts. Acellular dermal matrix was used to construct the ribs and stabilize the plugs of stem cells and bone. These procedures, in the hands of multispecialty physicians, have led to several successful reconstructions involving complex chest wall deformities. This surgical intervention was performed in a one stage operation. This represents the first successful complete sternal transplant in a patient with return to normal activities and increased quality-of-life.
Acellular Dermis ; Bone Marrow ; Congenital Abnormalities ; Fractures, Malunited ; Hand ; Humans ; Reconstructive Surgical Procedures ; Ribs* ; Stem Cells ; Sternotomy ; Sternum ; Thoracic Surgical Procedures ; Thoracic Wall ; Tissue Donors ; Transplants

Pectus arcuatum is a rare complex chest wall deformity. A 31-year-old female presented with a severely protruding upper sternum combined with a concave lower sternum. We planned a modified Ravitch-type operation. Through vertical mid-sternal incision, chondrectomies were performed from the second to fifth costal cartilages, saving the perichondrium. Horizontal osteotomy was performed in a wedge shape on the most protruding point, and followed by an additional partial osteotomy at the most concaved point. The harvested wedge-shape bone fragments were minced and re-implanted to the latter osteotomy site. The osteotomized sternum was fixed with multiple wirings. With chondrosternoplasty, a complex chest wall deformity can be corrected successfully.
Adult ; Bone Transplantation ; Congenital Abnormalities ; Costal Cartilage ; Female ; Funnel Chest ; Humans ; Osteotomy ; Pectus Carinatum ; Sternum ; Thoracic Wall

Sternal malformation/vascular dysplasia association is a rare congenital dysmorphology, which has not yet been reported in Korea. Its typical clinical features include a sternal cleft covered with atrophic skin, a median abdominal raphe extending from the sternal defect to the umbilicus, and cutaneous craniofacial hemangiomata. We report a case of a full-term newborn who presented with no anomalies at birth, except for a skin defect over the sternum and a supraumbilical raphe. Multiple hemangiomas appeared subsequently on her chin and upper chest wall, and respiratory distress due to subglottic hemangioma developed during the first 2 months of life. Her symptoms were controlled with oral prednisolone administration. No respiratory distress have recurred during the 3-year follow-up period.
Chin ; Follow-Up Studies ; Hemangioma ; Humans ; Infant, Newborn ; Korea ; Musculoskeletal Abnormalities ; Parturition ; Prednisolone ; Skin ; Sternum ; Thoracic Wall ; Umbilicus

Congenital sternal foramen is an anomaly whose occurrence is rare in human but is especially unusual in animals. This defect was formed when fusion of multiple ossification centers was incomplete. It may be associated with other lesions in body organs especially cardiac anomalies. In the present study, we report a very rare case of congenital sternal foramen in a Holstein calf. The oval defect was like a gunshot wound and located at the lower third of the sternum. Apparently, the rest of skeleton system seems normal. The awareness of the anomaly is important for better diagnosis and treatment of diseases.
Animals ; Bone Diseases ; congenital ; pathology ; veterinary ; Cattle ; Cattle Diseases ; congenital ; pathology ; Congenital Abnormalities ; pathology ; veterinary ; Sternum ; pathology

Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution.
Abdominal Muscles/abnormalities ; Abdominal Wall/abnormalities ; *Abnormalities, Multiple ; Diaphragm/abnormalities ; Echocardiography ; Female ; Humans ; Oligohydramnios/diagnosis ; Pregnancy ; *Pregnancy Complications ; Pregnancy Outcome ; Sternum/abnormalities ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. METHODS: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. RESULTS: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. CONCLUSION: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.
Chronic Pain ; Congenital Abnormalities ; Displacement (Psychology) ; Female ; Humans ; Kyphosis ; Male ; Medical Records ; Sternum ; Thoracic Wall ; Thorax ; Ventilators, Mechanical

A 6-year-old-man with a severe pectus excavatum and marfanoid feature was admitted for the correction of pectus excavatum. Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view. This method is that convex steel bar is inserted under the sternum through small bilateral thoracic incisions, and when it is in position, the bar is turn over, thereby correction the deformity. We experienced a case of the cardiac arrest during the rotation of a stainless steel bar. After the injection of atropine, epinephrine and the closed cardiac massage, sinus rhythm was restored. A vasovagal reflex due to the operation could be considered the possible etiology.
Atropine ; Congenital Abnormalities ; Epinephrine ; Funnel Chest* ; Heart Arrest* ; Heart Massage ; Humans ; Reflex ; Stainless Steel* ; Steel ; Sternum

Pectus excavatum in which the sternum is depressed and the anterior chest wall is concave in shape, is the most common congenital deformity to affect this region of the body. Various deformities involving depression or protrusion are caused by the degree and location of the sternal depression, and associated deformities such as a tilted sternum and anterior convexity of costal cartilages may occur. The most common associated disorders are Poland syndrome, Marfan syndrome and scoliosis.
Cartilage ; Congenital Abnormalities ; Depression ; Funnel Chest* ; Marfan Syndrome ; Poland Syndrome ; Scoliosis ; Sternum ; Thoracic Wall

Congenital defects of the sternum are rare development anomalies. They result form the failure of the lateral sternal bars to fuse. This malformation may be associated with other ventral midline fusion defects and ectopia cordis. A complete sternal cleft is the rarest form and less than 10 cases have been reported in the medical literature. Here were report a 3-day-old boy with complete sternal cleft without other malformations, who underwent primary surgical repair. Surgical correction of complete sternal cleft should be performed in neonatal period whether the infant if symptomatic or not because it is usually simple, able to achieve good result and primary repair is usually feasible at this period.
Congenital Abnormalities ; Ectopia Cordis ; Humans ; Infant ; Male ; Sternum