Management of a floating sternum after repair of pectus excavatum

Purpose: The aim of this study was to examine the authors' experience with patients who have floating sternum after correction of pectus excavatum via the classical Ravitch procedure. A floating sternum is defined as a sternu m in which the only attachment to the chest wall is its superior (cranial) border, and in which the body is secured only by the manubrium and whatever lateral and inferior fibrous bands are present. Typically, a floating ster num is caused by either extensive resection of the costal cartilages and pe richondrium during correction of pectus excavatum or failure of proper regr owth of these cartilages. Methods: The authors retrospectively assessed the charts of all patients di agnosed with a floating sternum noting age at original correction of pectus excavatum, time from original correction of pectus excavatum to diagnosis of floating sternum, age at correction of floating sternum, complaints befo re stabilization of the sternum, methods of repair, and postoperative compl ications. Results: Between July 1993 and June 1999, floating sternum was diagnosed in 7 patients. The mean age of patients who underwent operative correction of a floating sternum was 28.9 years (range, 16 to 42 years). The mean time i nterval between original correction of pectus excavatum, or "redo," and dia gnosis of a floating sternum was 9.9 years (range, 2 to 20 years). Complain ts before correction of the floating sternum included sternal pain and inst ability, exercise intolerance, and difficulty breathing. Operative repair c onsisted of mobilizing the lateral and inferior edges of the sternum, detac hing the fibrous perichondrium, performing anterior sternal osteotomies, an d finally supporting the sternum with substernal Adkins struts. All 7 patie nts had successful stabilization of the sternum. Two of 7 patients underwen t 2 procedures to successfully stabilize the sternum. One patient has Adkin s struts still in place because of hematopoetic malignancy. Six of 7 patien ts are now without symptoms. Conclusions: A floating sternum is a morbid phenomenon that may manifest ma ny years after the original procedure. It can cause significant sternal pai n, chest wall instability, and respiratory dysfunction, which are the hallm ark indications for correction. Repair of a floating sternum can be accompl ished successfully. J Pediatr Surg 36:159-164. Copyright (C) 2001 by W.B. S aunders Company.