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. 2015 Mar 25;10:40. doi: 10.1186/s13019-015-0241-x

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© Kim et al.; licensee BioMed Central. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Operative findings. (a) Lowermost costal cartilage resection is performed for cartilage approximation; (b) Approximations of both costal cartilages are attempted, but the high tension of the string tying the cartilages prevents obtaining optimal results; (c) Permacol® patch of size similar to the defect is temporarily affixed onto the left costal cartilage by using a 3–0 Ethibond and cut into the appropriate size. The stitches on the right side is close to the left suture site to minimize the size of the Permacol® patch for the approximation of costal cartilages, and the bottom area of the patch is used to reinforce the diaphragm and peritoneum defect areas; (d) follow up CT shows no thoraco abdominal defect at the heart protruding site (white arrow).