PMC8327679_01
Demonstration of the paradoxical movement of the lower chest wall
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F1
Physical examination revealed an enlargement of the caudal portion of the sternum and a laparoschisis responsible for a xypho-umbilical midline eventration that worsened with crying episodes (Fig. 1).
PMC8327679_02
Chest axial computed tomography (CT) scan (A) demonstrates lack of fusion of the sternal
margins, and (B) 3D reconstruction of the CT scan of the chest showing the edges of the lateral
sternal bards.
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F2
The chest computed tomography (CT) scan in axial sections with 3D parietal reconstruction showed the presence of small, rounded, hypodense and discontinuous formations corresponding to the ossification points in the upper part of the sternal edges and a sternal diastasis in the lower part (Fig. 2).
Intraoperative view of the reconstruction steps. Dissection of the anterioperiostem of the sternal bars which will be pulled medially and
posteriorly (A), (B) composite mesh used to reinforce the sternum, and (C) view of the completed repair.
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F3
The sternal bars were dissected free and isolated under the periosteum from the insertion of pectoralis major muscles anteriorly, and endothoracic fascia posteriorly (Fig. 3A). Each of the tips of the prosthesis were passed through the intercostal spaces (Fig. 3B), joined together and fixed with interrupted sutures without traction on the anterior surface body of the sternum (Fig. 3C).
PMC8327679_03
Closing of the gap between the two sternal bars behind the sternum by the prosthesis (green arrow)
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F4
The prosthesis compensated and bridged the gap between the two sternal bars (Fig. 4).