Reversed autogenous sternal plate flaps for treatment of sternal clefts: A novel technique

A sternal cleft is an extremely rare congenital anomaly resulting from a failure of the fusion of the sternal bars. The condition can be classified as complete or incomplete, where there is an inferior or less commonly a superior attachment. We report our experience with a modified surgical technique using a reverse autogenous sternal plate flap to treat complete sternal clefts in children beyond the neonatal period without the need for any prosthetic material or disruption of the chest wall structure.

The technique was performed on three patients beyond the neonatal period at the age of 2, 4 and 12years. Two patients were female and one was a male. All cases were performed by a single surgeon. Parents were consented for the new technique. Institutional review board (IRB) approval was obtained.

Recovery in all children was uncomplicated, and they were discharged home after 4, 4 and 5days respectively. There were no morbidities among all 3 patients. Review at 4 and 12weeks revealed complete wound healing and a well-united sternum. All remain asymptomatic on a median follow-up period of 22months.

Our new technique in repairing complete sternal clefts was easy, reproducible and generated satisfactory results on a reasonable follow up period. Most importantly we avoided the use of prosthetic material and any disruption to the chest wall structure in a subgroup of older patients.