Patient-specific 3D-printed scaffold for pediatric superior sternal cleft repair.

RATIONALE: Sternal cleft is a rare congenital chest wall defect resulting from failed fusion of the sternal bars during embryogenesis. Primary closure is often feasible in the neonatal period due to thoracic wall compliance, but delayed presentations require complex reconstruction using autologous tissues, muscle flaps, and/or biomaterials. PATIENT CONCERNS: A two-year-old male presented with a visible anterior chest wall defect and progressive respiratory distress. DIAGNOSES: Physical examination revealed an isolated superior sternal cleft with visible cardiac pulsations beneath the skin. Three-dimensional computed tomography (3D-CT) confirmed the defect dimensions and sternal configuration. INTERVENTIONS : A patient-specific biodegradable scaffold composed of polycaprolactone (PCL) + hyaluronic acid + β-tricalcium phosphate (β-TCP) was designed using CAD-CAM workflows and produced with 3D printing. The scaffold was fixed to the sternal periosteum with non-absorbable sutures and reinforced with bilateral pectoralis major muscle flaps. OUTCOMES : No intraoperative complications occurred. The patient was extubated at 12 h, monitored in the intensive care unit for 2 days, and discharged on postoperative day 7. At the 1- and 3-month follow-ups, respiratory symptoms had resolved; chest wall stability and cosmetic appearance were satisfactory; and imaging confirmed implant stability. LESSONS : Patient-specific 3D-printed biodegradable implants can provide a safe and anatomically conforming option for pediatric sternal cleft repair when primary closure is not feasible.