Ectopia cordis is a very rare congenital anomaly associated with a hig
h mortality rate. A successful repair of ectopia cordis with complete
absence of sternum was achieved in a two-stage procedure, Initial mana
gement consisted of coverage of skin over the malpositioned heart usin
g bilateral pectoral skin flaps, A second more definitive repair was u
ndertaken at age 14 months, Four methyl methacrylate struts were used
to reconstruct the anterior chest wall and were then covered with bila
teral pectoralis major muscle flaps. At the 2.5-year follow-up there i
s no evidence of cardiopulmonary compromise and the development of the
thorax appears normal. We advise that use of alloplastic materials is
a valid option in managing this difficult congenital anomaly.