Effects of the Nuss procedure on chest wall kinematics in adolescents with pectus excavatum

Abstract A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: ‘In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?’ Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.

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Radiological changes after Nuss operation for pectus excavatum

Medicina ◽

10.3390/medicina45090091 ◽

2009 ◽

Vol 45 (9) ◽

pp. 699 ◽

Cited By ~ 9

Author(s):

Artūras Kilda ◽

Saulius Lukoševičius ◽

Vidmantas Barauskas ◽

Živilė Jankauskaitė ◽

Algidas Basevičius

Keyword(s):

Chest Wall ◽

Pectus Excavatum ◽

First Year ◽

Nuss Procedure ◽

Funnel Chest ◽

Haller Index ◽

Wall Deformation ◽

Lateral Chest ◽

Radiological Changes ◽

The Mean

The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. Materials and methods. Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. Results. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012). Conclusions. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.

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Three-Dimensional Simulation for Breast Augmentation of Female Asymmetric Pectus Excavatum: A Case Report

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojz010 ◽

2019 ◽

Vol 1 (2) ◽

Author(s):

Yoshichika Yasunaga ◽

Aya Tsuchiya ◽

Yuta Nakajima ◽

Shoji Kondoh ◽

Masahiko Noguchi ◽

...

Keyword(s):

Chest Wall ◽

Breast Augmentation ◽

Pectus Excavatum ◽

Three Dimensional ◽

Anterior Chest Wall ◽

Nuss Procedure ◽

Breast Asymmetry ◽

Level Of Evidence ◽

Dimensional Simulation ◽

The Right

Abstract Breast augmentation for women with asymmetric pectus excavatum (PE) has a characteristic problem in that surgeons need to select implants while considering the left-right difference in breast volume, contour, and position. We herein report a 33-year-old woman with severe asymmetric PE who presented with residual breast asymmetry after chest wall correction using the Nuss procedure. Her right breast appeared hypoplastic and the right anterior chest wall remained depressed. Augmentation of the right breast with a silicone implant was performed, selecting the inserted implant preoperatively with the assistance of three-dimensional (3D) simulation. The breast asymmetry and anterior chest wall depression were improved to a natural appearance. Three-dimensional simulation represents an advantageous way to preoperatively select optimal implants for breast augmentation in asymmetric PE women with breast asymmetry. Level of Evidence: 5

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Analysis of chest wall elevation after the Nuss procedure using 3D body scanning technique in patients with pectus excavatum

Pediatric Surgery International ◽

10.1007/s00383-021-04885-3 ◽

2021 ◽

Author(s):

Sadashige Uemura ◽

Atsushi Yoshida ◽

Hisako Kuyama

Keyword(s):

Chest Wall ◽

Pectus Excavatum ◽

Nuss Procedure ◽

Body Scanning ◽

Scanning Technique

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Computer-Aided Design and Manufacturing Technology for Identification of Optimal Nuss Procedure and Fabrication of Patient-Specific Nuss Bar for Minimally Invasive Surgery of Pectus Excavatum

Applied Sciences ◽

10.3390/app9010042 ◽

2018 ◽

Vol 9 (1) ◽

pp. 42 ◽

Cited By ~ 4

Author(s):

Yoon-Jin Kim ◽

Jin-Young Heo ◽

Ki-Hyun Hong ◽

Hoseok I ◽

Beop-Yong Lim ◽

...

Keyword(s):

Chest Wall ◽

Computer Aided Design ◽

Pectus Excavatum ◽

Optimal Operation ◽

Numerical Control ◽

Patient Specific ◽

Nuss Procedure ◽

Computer Aided ◽

Aided Design ◽

Design Drawing

The Nuss procedure is one of the most widely used operation techniques for pectus excavatum (PE) patients. It attains the normal shape of the chest wall by lifting the patient’s chest wall with the Nuss bar. However, the Nuss bar is for the most part bent by a hand bender according to the patient’s chest wall, and this procedure causes various problems such as the failure of the operation and a decreased satisfaction of the surgeon and patient about the operation. To solve this problem, we proposed a method for deriving the optimal operation result by designing patient-specific Nuss bars through computer-aided design (CAD) and computer-aided manufacturing (CAM), and by performing auto bending based on the design. In other words, a three-dimensional chest wall model was generated using the computed tomography (CT) image of a pectus excavatum patient, and an operation scenario was selected considering the Nuss bar insertion point and the post-operative chest wall shape. Then, a design drawing of the Nuss bar that could produce the optimal operation result was derived from the operation scenario. Furthermore, after a computerized numerical control (CNC) bending machine for the Nuss bar bending was constructed, the Nuss bar prototype was manufactured based on the derived design drawing of the Nuss bar. The Nuss bar designed and manufactured with the proposed method has been found to improve the Haller index (HI) of the pectus excavatum patient by approximately 37% (3.14 before to 1.98 after operation). Moreover, the machining error in the manufacturing was within ±5% compared to the design drawing. The method proposed and verified in this study is expected to reduce the failure rate of the Nuss procedure and significantly improve the satisfaction of the surgeon and patient about the operation.

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