Sternotomy healing by secondary intention in a complex single ventricle patient after stage 1 palliation

Delayed sternal closure is an important and commonly utilized strategy in neonates following cardiac surgery to optimize postoperative cardiac output. We present the case of an infant with hypoplastic left heart syndrome (HLHS) who underwent stage 1 Norwood/Sano palliation and did not tolerate sternal closure in the immediate post-op period, even when attempted after delay, due to persistent hemodynamic instability. Our approach involved closure of the skin and subcutaneous tissue to allow for sternotomy healing by secondary intention. This technique may be considered in rare instances when delayed sternal closure is not possible.