Current Thoracic Surgery

Ectopia cordis is a rare and frequently fatal congenital anomaly characterized by partial or complete displacement of the heart outside the thoracic cavity due to defective midline fusion during embryogenesis. Surgical management remains challenging because of the associated cardiac and chest wall defects. A 37-week gestational age neonate presented with thoracic ectopia cordis, atrial septal defect, pericardial defect, and complete sternal aplasia. On day 29 of life, after hemodynamic stabilization and multidisciplinary operative planning, the patient underwent combined cardiovascular and reconstructive surgery. Following cardiac repositioning into the thoracic cavity and pericardial reconstruction using a bovine pericardial patch, chest wall reconstruction was performed with bipedicled fasciocutaneous flaps harvested from the pectoral region. Initial postoperative recovery was complicated by suture line necrosis, which required surgical debridement and Z-plasty reconstruction. Subsequent patch exposure was successfully managed with patch excision, flap release, medial advancement, repeat Z-plasty reconstruction, and wound dressings. Wound cultures demonstrated no significant bacterial growth. Complete secondary healing was achieved without additional complications. Thoracic ectopia cordis requires individualized multidisciplinary management and careful staged reconstruction. Bipedicled fasciocutaneous flaps provided reliable soft tissue coverage and allowed successful reconstruction following postoperative wound complications. Flexible reconstructive strategies and close postoperative monitoring may improve outcomes in these complex patients.