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Arch Plast Surg > Epub ahead of print
DOI: https://doi.org/10.5999/aps.2018.00829    [Epub ahead of print]
Published online April 11, 2019.
Successful management of absent sternum in an infant using porcine acellular dermal matrix
Roy Alfred Semlacher1  , Muhammand A.K. Nuri2
1Department of Plastic and Reconstructive Surgery, Mary Bridge Children’s Hospital & Health Network, MultiCare Health System, Tacoma, WA, USA
2Seattle Children’s and Mary Bridge Children’s Regional Cardiac Surgery Program, Tacoma, WA, USA
Correspondence:  Roy Alfred Semlacher, Tel: +1-253-403-2120, Fax: +1-253-403-2654, 
Email: rsemlacher@multicare.org
Received: 10 July 2018   • Revised: 26 October 2018   • Accepted: 15 December 2018
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: Sternum / Acellular dermis / Surgical mesh / Thoracic surgery / Negative pressure wound therapy
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