Delayed sternal closure: a lifesaving maneuver after early operation for complex congenital heart disease in the neonate.

Early repair of complex congenital heart malformations may lead to life-threatening respiratory and hemodynamic embarrassment on sternal closure. To avoid a fatal outcome in these situations, we postponed sternal closure in nine critically ill neonates by suturing silicone elastomer sheeting to the skin edges. This maneuver, in a setting of optimal inotropic and ventilatory support, allowed eight of the nine neonates to survive. The mean age at operation was 10.2 days (range 3 to 31). The mean preoperative weight was 3004.4 gm (range 1550 to 3780). The sternal wound was protected with an impervious silicone elastomer sheeting for a mean of 5.6 days (range 2 to 12). There was no instance of wound infection. The judicious application of this technique after operations for complex congenital heart disease can provide the necessary compliance vital for immediate cardiopulmonary performance and ultimate survival.