Isolated V-Shaped Sternal Cleft — A Rare Chest Wall Malformation

Figures & data

Figure 1 Stepwise approach for management of sternal cleft.

Figure 2 Preoperative: (A) defect on the anterior chest wall with scar-like hypopigmented skin and supraumbilical raphe; (B) marked V-shaped sternal defect.

Figure 3 Intraoperative: (A) vertical incision was made, followed by raising skin flap; (B) exposing sternal bars and pectoralis major muscle flaps. The two halves were freed of underlying pleura and pericardium.

Figure 4 Immediately postprocedure: (A) approximation of sternal bars and muscle flaps done; (B) complication of inward chest retraction is not seen.

Figure 5 Postoperative: (A) the incision closed layer by layer, cleaned; (B) observed for infection at 2–7 days; (C) at discharge.

Table 1 Summary of seven case reports presented with different types of sternal defect, associated syndromes or anomalies and various techniques of management^2,3,6,8–10

	Case 1	Case 2	Case 3	Case 4	Case 5/6	Case 7
Year of birth	2013	2015	2010	2017	2017/2017	2005
Sex	Female	Female	Male	Female	Male/female	Female
GA	Term	Terms	Term	Term	Term/Term	Term/Tw.B
Weight at birth	2440gram	3100 g	2500 g	—	2410/3000 g	2790 g
Prenatal Dx	No	No	No	No	No/no	Yes, at 22 weeks GA
Type of sternal defect	Complete	Complete	Superior partial	Complete	Inferior/superior	Complete
Associatd syndrome or anomalies	—	Giant aortic aneurysm, DCM, interventricular defect, heart failure	Facial heamgioma	PDA, patent foramen ovale	Cardiac, VSD, TR, ectopia,cordis	Cardiac Secondum ASD
Management done: surgery	At 12 days, muscle flaps and approximation	Hospitalized till 10 days	At 18 days, primary approximation	Followed, no surgery done	At 18 months, pectoralis and abd. rectus muscle flap, rib graft	At 2 months, repair and bridged with marlex mesh
Follow-up and outcome	No complications, follow-up at 3, 6, 9 months	Death at 11th day of life	No complications, followed for 1 year	Good condition	Followed 6 months, 1 year Good condition	6 months Good condition
Authors	Zamrif et al	Fouzia et al	Singh et al	Anda et al	Alshomer et al	Twomey et al

Abbreviations: Dx, diagnosis; GA, gestational age; DCM, dilated cardiomyopathy; ASD, atrial septal defect; VSD, ventricular septal defect; PDA, patent ductus arteriosus.

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