The Institute of Chest Wall Surgery
Sternal Cleft and Abdominal Wall Defect Surgery in a 5-Month-Old Infant
Medical History
The patient is a 5-month-old female infant born with a longitudinal midline scar extending from the chest to the abdomen, along with a congenital absence of the bony structures of both the upper sternum and the upper abdominal wall. Since birth, she has experienced two episodes of pneumonia, both complicated by severe respiratory distress. Her condition stabilized after emergent medical intervention.
Preoperative Examination
There is a prominent longitudinal scar along the midline of both the anterior chest wall and the abdominal wall, extending from the chest wall to the umbilicus. The upper part of the sternum is split along the midline, with only a minimal bony structure remaining connected at the very bottom of the sternum (above the xiphoid process), forming a "V"-shaped defect. Meanwhile, the upper abdominal wall is also split along the midline, resulting in an inverted "V"-shaped defect. Additionally, paradoxical breathing is evident in both the upper chest wall and upper abdominal region. The echocardiography shows no structural cardiac abnormalities. The child was ultimately diagnosed with sternal cleft combined with abdominal wall defect.
Surgical Overview
A midline incision was made along the anterior chest wall, beginning from the sternoclavicular joints and extending downward to the upper abdominal wall. For the sternal defect area, reconstruction was performed using the MatrixRIB bars. The ends of the bars were precisely fixed onto the residual bony structure at the lower end of the sternum. Meanwhile, appropriate reinforcement was carried out at the costal cartilages to enhance stability.
After eliminating the chest wall defect as much as possible, a patch was placed inside the thoracic cavity to prevent adhesion between the bars and thoracic organs. Subsequently, another patch was applied over the surface of the thoracic cavity to further reinforce the bars and ensure the effectiveness of the reconstruction.
For the defect in the upper abdominal wall, the same approach as for the chest wall defect was employed, utilizing two patches for reconstruction and reinforcement. Finally, the edges of the patch covering the surface of the abdominal wall were securely fixed to the costal arch to maintain its stability.
The surgery was completed successfully without complications. Postoperatively, the appearance of the chest and abdominal wall returned to normal, and paradoxical breathing was completely resolved.
Related Photos
What is paradoxical breathing？
Paradoxical breathing is an abnormal respiratory pattern characterized by the chest or abdomen moving in the opposite direction to normal respiratory motion.
Under normal circumstances, the chest wall expands and the abdomen protrudes during inhalation, while the chest wall contracts and the abdomen sinks during exhalation. In paradoxical breathing, however, the chest wall collapses and the abdomen sinks inward during inhalation, and protrudes outward during exhalation.
This unusual movement pattern often indicates a significant structural problem in the chest wall.
Paradoxical breathing is commonly seen in the following three types of chest wall disorders:
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Severe chest wall trauma, such as multiple rib fractures.
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Chest wall deformities involving rib absence, such as Poland syndrome or thoracic insufficiency syndrome.
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Chest wall depression deformities, such as pectus excavatum.
It is worth noting that protruding chest wall deformities, such as pectus carinatum, typically do not cause paradoxical breathing.
Paradoxical breathing caused by chest wall disorders can significantly impair normal respiratory function. It may lead to hypoxia, shortness of breath, and further compromise the cardiopulmonary system. Early recognition is essential—prompt medical evaluation can help identify the underlying cause and allow for timely, targeted intervention.