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

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 Creactive 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.

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

Fig. 1.. Thoracic CT showing absent sternum before reconstruction

(A) Computed tomography (CT) and (B) 3-dimensional reconstruction of patient’s thoracic cage at age 3 days, before sternal reconstruction. Note absence of sternum and open shape of thoracic cage, with left and right ribs in parallel, rather than curved.

Fig. 2.. Thoracic CT 9 months after sternal reconstruction

(A) Computed tomography (CT) image and (B) 3-dimensional reconstruction of patient’s thoracic cage 9 months after sternal reconstruction with acellular dermal matrix. Note normal anterior curvature of ribs, as would occur in the presence of a sternum.

Fig. 3.. Patient at 3 years after sternal reconstruction

Photograph of patient 3 years after acellular dermal matrix-based sternal reconstruction. The wound has fully healed and the thoracic cage shows normal structure and development.