Technically we can divide full-thickness thoracic reconstruction into 2 parts: providing a rigid support and ensuring well-vascularized coverage. Since 1986, the authors' center has had ample experience with bone banks and the use of cryopreserved bone grafts, which led them to consider the possibility of using these grafts for full-thickness chest wall reconstruction. They describe 3 patients in whom resection of the tumor and reconstruction of the thorax were carried out using iliac bone allografts covered with muscle flaps (1 pectoralis major and 2 rectus abdominis). None of the patients experienced breathing difficulties, pain, or instability after 14 months, 18 months, and 11 years of follow-up. The result of the reconstruction was excellent in all 3 patients in terms of function and aesthetics. The advantage of allografts compared with synthetic materials is their potential integration; they can become part of the host patient's living tissue.

Chest Wall Reconstruction Using Iliac Bone Allografts and Muscle Flaps

We report the surgical management of a 3 day old baby with absent sternum and pericardium with impending rupture of the skin cover. The repair described is innovative and may be used in place of primary repair by bringing the ribs together. Review of embryology and various modalities of closure are provided.

Surgical reconstruction for absence of sternum and pericardium in a newborn.

Pentalogy of Cantrell is a rare entity of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium and heart. The complete pentalogy and its variants have been described in the literature. We report a 47-day-old girl with an incomplete pentalogy of Cantrell presenting with congenital absence of the sternum, congenital heart defects, and an epigastric hernia. Two even rarer expressions of this disorder, tricuspid atresia type IIc and asymmetric kidneys, were also found. The patient was successfully managed with palliative pulmonary artery banding as preparation for a modified Fontan operation when she is older. We report this rare case, and discuss the pathologic findings and surgical strategy.

An incomplete pentalogy of Cantrell.

We describe a simple technique for chest wall reconstruction in pentalogy of Cantrell using split-thickness cartilage grafts. This technique provides a robust reconstruction, gives immediate and excellent cosmetic results, allows for skeletal and tissue growth, and avoids the use of synthetic material.

Split-thickness cartilage grafts for chest wall reconstruction in pentalogy of Cantrell.

A 4 year old Yemeni girl was admitted to King Khalid University Hospital, Riyadh, in January 1985 with a history of recurrent chest infection and bluish discolouration of her lips when she cried excessively. She was the child of a consanguineous marriage and was delivered normally at full term. On examination there was a depression over the sternal area of the chest. The overlying skin, measuring 7 x 5 cm, was replaced by a papery thin hypopigmented scar, which flapped in and out during respiration. The scar extended down along the midline to the umbilicus (fig 1). Bony resistance was not felt underneath the scar. The medial ends of the clavicles and the anterior ends of the ribs were felt in a row, away from the midline. Plain radiography of the chest showed complete absence of the sternum. This was confirmed by computed tomography and a bone scan (using technetium methylene diphosphonate). Surgical correction was undertaken after correction of anaemia. At operation the scar, which was firmly adherent to the pericardium, was carefully excised. The pectoral fascia was then widely mobilised from each side and approximated in the midline with 3/0 prolene. As soon as the fasciorrhaphy was complete the mediastinal flutter disappeared. A rectus abdominis myocutaneous flap, based on the left superior epigastric vessels, was used to provide skin cover. Preoperative internal mammary angiography confirmed the presence of the left superior epigastric artery. The postoperative period was uneventful. The child has a well stabilised chest wall and is healthy and symptom free 15 months after operation.

https://thorax.bmj.com/content/thoraxjnl/42/10/829.full.pdf

Mandke Nv

Papers

Surgical correction of absent sternum with homologous rib graft.