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.