Asymptomatic sternal cleft: is the repair necessary only for aesthetical reasons?
May 5th, 2009 • Fente sternale, Pourquoi ça n'arrive qu'à moi?
Contrary to what I’ve been told so far, that in the case of asymptomatic sternal clefts, a surgical intervention was recommended only for aesthetical reasons, I’ve found two articles on sternal cleft surgery stating that sternal clefts should be corrected and giving a series of indications beyond aesthetics.
These articles also outline the importance of addressing base by case, as sternal clefts, with r without ectopia cordis, represent a rare clinical entity:
and also, more detailed:
When I read this, two indications worry me “Enlargement of the defect over time will worsen in appearance and make it more difficult to correct” and also “paradoxic respiratory movements of the chest induce dyspnea and presispose patients to recurrent respiratory infections”.
I wonder then, why the doctors affirmed that leaving unrepaired Priel’s sternal cleft would not have any consequence in her future development.
Dr Alexander Fokin is the author of the first fragment cited here that comes from Alexander A. Fokin and Francis Robicsek, Management of chest wall deformities in Advanced therapy in thoracic surgery, Kenneth L. Franco, Joe Billy Putnam, Robert S. D. Higgins, J Sanchez, PMPH-USA, 2005, 548 pp. He is also cited as main reference for his classification of indications for sternal cleft repair in: Michael J. Sundine, Treatment of sternal clefts in Reconstructive Surgery of the Chest, Abdomen, and Pelvis, Gregory R. D. Evans, Informa Health Care, 2004, 473 pp.
One Response (Add Your Comment)
-
Faiza Khan May 5, 2009at 10:39 am
Fil des billets
Hi, I got in touch with you over twitter following @NergizK tweet about your quest for information about sternal cleft. So here is my take on it: I think that Incomplete sternal clefts should be evaluated, diagnosed and surgically corrected as soon as possible, after ruling out all the possible associated and unassociated congenital anomolies and malformations. If any other anomolies co-exist then first they should be evaluated and corrected if possible, especially if there is something abnormal in the development or functioning of the heart or blood vessels which may hinder, hamper or worsen the patient or make it unsafe for her to undergo anesthesia. When you get a good to go on this phase, then in my opinion, the surgical correction should be done ASAP. I do not want to repeat the reasons explained in the articles you have already read and shared with us, just want to say that i agree with the reasons fully and they are unrefutable. Moving forward, id like to try to lessen your anxiety and confusion about this procedure and talk about Why you are so scared to make this life saving decision for your daughter? The reasons which i have found so far are that you are(and i could be wrong):
1: Confused by the lack of or limited guidance. 2: Overwhelmed by the enormity of the decision. 3: You dont want her to have any pain inflicted on her. 4: cosmetical reason: resultant scar, for which she might be mad at you when she grows up. 5: Side effects and recovery time concerns. and well..there could be many more…? or even less…?
So, to address this at a mom-to-mom level, id say that please dont be confused or overwhelemed by this decision. Confusion drives a person crazy and hampers clear thinking. Be detached from her for a moment (if thats possible) and just look at her! and dont be afraid! She was born with a malformation which can be corrected in this day and age with proper medical and surgical treatment, you are lucky to be able to afford it and this will not be the first time this procedure will be done. EVen if you talk to other families with same issue and surgeries, you will never get a satisfactory answer because every case, every human being is unique. Lots of other factors effect the outcome of a surgery, its not a calculator which will always say 4 if you add 2 and 2. As for pain, kids are very resilient,so with the support of current available medicines and painkillers she should recover in her time. There are things for scars, cosmetic surgeries and stuff, but you know what? you could even be surprised if you let her grow with the scar and explain it to her that how proud you are that she was brave enough to go through the whole thing and its a sign of God on her chest which says how much He loves you and has protected you. You know…you can say a lot to make her feel happy about it, instead of being ashamed and all. But again teenagers are very troublesome and unpredictable, but when you weigh the pros and cons of the surgery, to me, pros outweigh the cons pretty well! You will be saving her from potential traumas to the chest which could injure the vital organs, she will be able to join in sports which she would generally be ousted because of the danger of getting hurt. The cleft itself is a cosmetic issue, so weigh the scar against the cleft and then decide which is safer for your precious child. And the longer you take to make up your mind, the harder it will be for the doctors to perform the surgery as the bones would have fused and matured. I am afraid you will never be able to understand all the quirks of the surgery, you already have a general idea, so try to form a decision based on it please.
So i would encourage you to think about it (well thats what you are already doing past 4 yrs) and i hope you make the right choice which is good for your child. I have only expressed my opinion, you know your daughter’s full medical history, the availability of good surgeons and care, and ofcourse finances. I can only pray that all remains well with your daughter and may she be happy always.
Lots of hugs for your daughter. Faiza