Arch Plast Surg.  2019 Sep;46(5):470-474. 10.5999/aps.2018.00829.

Successful management of absent sternum in an infant using porcine acellular dermal matrix

• Semlacher
• Nuri MA

• KMID: 2464624
• DOI: http://doi.org/10.5999/aps.2018.00829

Abstract

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.

Keyword

Sternum; Acellular dermis; Surgical mesh; Thoracic surgery; Negative pressure wound therapy

MeSH Terms

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
C-Reactive Protein