Deformities of the Thoracic Wall: Don't Forget the Plastic Surgeon

2018 ◽  
Vol 28 (04) ◽  
pp. 361-368 ◽  
Author(s):  
Anton Schwabegger
Keyword(s):  
Pectus Excavatum ◽  
Treatment Options ◽  
Costal Cartilage ◽  
Anterior Wall ◽  
Thoracic Wall ◽  
Reconstructive Procedures ◽  
Chest Deformity ◽  
Aesthetic Results ◽  
Pectus Bar ◽  
Single Method

AbstractSurgical procedures for pectus excavatum (PE) repair, such as minimally invasive repair of pectus excavatum or similar interventions (modified open videoendoscopically assisted repair of pectus excavatum), for remodeling the anterior thoracic wall may finally not always achieve sufficiently pleasing aesthetic results. Particularly in the asymmetric and polymorphic cases, remnant deformities may still be present after any sophisticated remodeling attempt. On the other hand, some cases despite optimal surgical management develop mild recurrences with partial concavity or rib cartilage distortion shortly after pectus-bar removal. Secondary treatment options then may include open access surgery, resection, or reshaping of deformed and prominent costal cartilage. Residual concave areas can be filled by autologous tissue, such as cartilage chips, liposhifting, or implantation of customized alloplastics. To provide the best options for a variety of primary or secondary postsurgical expressions of anterior wall deformities, any physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques or at least should have knowledge of such. However, among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. Careful selection of appropriate techniques, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be mandatory, based on the heterogeneity of symptoms, severity, expectations, and surgical and technical resources. A variety of such ancillary reconstructive procedures for PE repair are explained and illustrated herewith.

scholarly journals Minimal invasive surgical correction of pectus excavatum deformities in adolescents: Our institutional experience

2013 ◽  
Vol 141 (7-8) ◽  
pp. 503-506
Author(s):  
Radoica Jokic ◽  
Dragan Kravarusic ◽  
Milos Pajic ◽  
Jelena Antic ◽  
Zoran Vukasinovic
Keyword(s):  
Pectus Excavatum ◽  
Operative Time ◽  
Postoperative Recovery ◽  
Metal Plate ◽  
Minimal Invasive ◽  
Nuss Procedure ◽  
Chest Deformity ◽  
Institutional Experience ◽  
Pectus Bar ◽  
Invasive Surgical Approach

Introduction. Nuss procedure is a minimal invasive surgical technique based on retrosternal placement of a metal plate to correct pectus excavatum chest deformity. We are presenting our five?year (2006?2011) institutional experience of 21 patients. Objective. The aim of this study was to determine characteristics and advantages of minimal invasive surgical approach in correcting deformities of the chest. Methods. Surgical procedure, named after its author Nuss, involves the surgical placement of a molded metal plate, the so?called pectus bar, behind the sternum under thoracoscopic view whereby immediate controlled intraoperative corrections and stabilizations of the depression can be made. The great advantage of this method is reflected in a significant shortening of operative time, usually without indications for compensation in blood volume, and with a significantly shortened postoperative recovery that allows patients to quickly return to their normal activities. Results. In the period 2006?2011, 21 patients were operated by the Nuss procedure. The pectus bar was set in front or behind the muscles of the chest. Among the complications listed were inflammation of wounds in three patients, dislocation (shifting) of the bar requiring a reoperation in two patients, an occurrence of a pericardial effusion in one patient, and allergic response to foreign body in one patient. Five patients required extraction of the bar two years later, and three patients after three years, all with excellent results. Conclusion. Minimally invasive Nuss procedure is safe and effective. It currently represents the primary method of choice for solving the chest deformity pectus excavatum for patients of all ages. Modification of thoracoscopic control allows a safe field of operation. Postoperative results are excellent with very few complications that can be attributed to the learning curve.

scholarly journals Video thoracoscopic treatment of pectus excavatum with the minimally invasive technique nuss

2020 ◽  
Vol 6 (2) ◽  
pp. 41-43
Author(s):  
Sergio Polliotto
Keyword(s):  
Pectus Excavatum ◽  
Average Rate ◽  
Operating Time ◽  
Anterior Wall ◽  
Invasive Technique ◽  
Origin And Evolution ◽  
Treatment Techniques ◽  
Aesthetic Results ◽  
Average Operating Time ◽  
The Aesthetic

Introduction: The pectus excavatum is a mmon malformation of the anterior wall of the thorax, characterized by a depression of the sternum and impaired sternal condro joints. In most cases, congenital in origin and evolution. Reaches its greatest deformity in adolescence. For many surgical treatment techniques involving extensive resections of costal cartilages and mobilization of the sternum were used. In 1998 Donald Nuss describes a technique where video thoracoscopic introduces a sternal retro metal bar, which is inserted through a small incision on each side of the chest wall, malformation running without resection of costal cartilages or section and / or and/or sternal mobilization. Goals: To report our experience in two surgical centers, for pectus excavatum the treatment with the technique of video thoracoscopic Nuss. Work retrospective, descriptive. Materials and methods: Work retrospective, descriptive. From December 2015 to December 2019 surgically treat pectus excavatum 72 patients using the technique video thoracoscopic Nuss. Results: 63 males and 9 females. The age range at the time of surgery was 7 to 18 years (mean 15.7). Six patients older than 18 years were excluded from the sample. The average rate for Haller in this population was 4.1. All patients got a metal bar sternal retro video thoracoscopic under control, side stabilizers were placed in all patients (65 bilateral and 7 unilateral). Epidural catheter was placed for postoperative analgesic analgesia management in 100% of cases. The average operating time was 94 min. (70-110 min). Intra-operative difficulties: one bar too high had to reposition itself in the same surgical procedure, the mean average hospitalization was 9.7 days (5 -27 days). Post operative complications: The most common early complication was pneumothorax self-limiting in patients 11 (15.2%). The most severe complication was purulent pneumonia with effusion and pleural drainage needed toilette video thoracoscopy 1 (1.3%). Three patients (4.1%) had granulomas wound. Late migration of the bar that was surgically corrected with good outcome. In 65 (90%) patients, the results were very good and good; 5 (6.9%) regular and 2 (2.7%) bad due to the presence of asymmetry chest. Conclusions: Thoracoscopic technique video Nuss is safe, effective and reproducible for the treatment of patients with pectus excavatum. Parietal approach a minimum and low morbidity. The aesthetic results are very satisfactory.

scholarly journals Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in a Patient with Recurrent Pectus Excavatum

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Jinhee Ahn ◽  
Jong-Il Choi ◽  
Jaemin Shim ◽  
Sung Ho Lee ◽  
Young-Hoon Kim
Keyword(s):  
Pectus Excavatum ◽  
Surgical Correction ◽  
Mechanical Compression ◽  
St Segment Elevation ◽  
Skeletal Anomaly ◽  
St Segment ◽  
Chest Deformity ◽  
The Right ◽  
Electrocardiogram Ecg ◽  
Benign Course

Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS).

Pectus excavatum repair using bridge fixation system

2019 ◽  
Vol 27 (5) ◽  
pp. 374-380
Author(s):  
Vu Huu Vinh ◽  
Huynh Quang Khanh ◽  
Nguyen Hoang Binh ◽  
Nguyen Van Khoi
Keyword(s):  
Postoperative Complications ◽  
Pectus Excavatum ◽  
Fixation Method ◽  
Fixation Techniques ◽  
Pectus Bar ◽  
Skin Surgery ◽  
The Stability ◽  
Skin To Skin ◽  
Average Skin ◽  
Fixation System

Background The stability of the pectus bar is an important determinant of the success of pectus excavatum repair surgery. In practice, several different types of fixation method are in use for stabilizing pectus bars. The aim of this study was to compare the performance of the bridge fixation system with previous fixation systems for stabilizing pectus bars. Methods We performed a retrospective review of 1760 pectus excavatum repair cases conducted in the Thoracic Department of Choray Hospital and its satellite hospitals, between 2007 and 2017. We compared the results of 560 patients who had the bridge fixation system with the previous 1200 patients who had other fixation techniques. Results The bridge fixation system with 2 bars in 560 patients gave better results in terms of bar stabilization, operative time, and postoperative complications, compared to the previous 1200 patients who had other stabilization techniques. The average skin-to-skin surgery time using the bridge fixation system was 55 min. Of the 560 cases, only one patient showed trivial one bar dislocation, and one had a postoperative complication (pneumothorax). Conclusions We found the bridge fixation system to be superior not only in terms of stabilizing the bars but also for minimizing the time of surgery and postoperative complications, compared to other fixation systems. The bridge fixation system with 2 bars showed excellent results. Use of 3 bars is not necessary. One bar was used in the other fixation techniques and the results were found to be inferior compared to those using 2 bars.

scholarly journals Treatment of bilateral mammary ptosis and pectus excavatum through the same incision in one surgical stage

2012 ◽  
Vol 130 (3) ◽  
pp. 198-201 ◽  
Author(s):  
Fernando Passos Rocha ◽  
Jefferson André Pires ◽  
Vinicius Franchini Torres ◽  
Djalma José Fagundes
Keyword(s):  
Pectus Excavatum ◽  
Surgical Techniques ◽  
Breast Implants ◽  
Self Esteem ◽  
Young Female ◽  
Thoracic Wall ◽  
Congenital Deformities ◽  
Bone Segment ◽  
Mammary Ptosis ◽  
Invasive Techniques

CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem.

scholarly journals Sternal elevation techniques during the minimally invasive repair of pectus excavatum

2019 ◽  
Vol 29 (4) ◽  
pp. 497-502 ◽  
Author(s):  
Frank-Martin Haecker ◽  
Thomas Krebs ◽  
Gregor J Kocher ◽  
Ralph A Schmid ◽  
Sergio B Sesia
Keyword(s):  
Side Effects ◽  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Skin Incision ◽  
Technical Equipment ◽  
Nuss Procedure ◽  
Review Of The Literature ◽  
Different Types ◽  
Pectus Bar ◽  
Number Of Authors

Summary The aim of the review was to evaluate the routine use of sternal elevation techniques (SETs) during minimally invasive repair of pectus excavatum (MIRPE, the Nuss procedure). We performed a review of the literature between January 1998 and September 2018 with focus on different methods of SET during MIRPE. Reported effects and side effects were evaluated and compared with our own experience concerning the routine use of the vacuum bell for sternal elevation during MIRPE during the last 13 years. SET is more often used in adult patients than in adolescents. SET improves visualization and safety of MIRPE. Advancement of the pectus introducer, retrosternal dissection and placement of the pectus bar are easier. The risk of cardial and/or pericardial lesion is reduced significantly. Different types of retractors, a crane combined with a wire and/or customized hooks are reported to be used as SET. Furthermore, routine use of a subxiphoid incision is reported. However, more technical equipment, and in some SETs additional incisions are necessary. In contrast, no additional skin incision is necessary for the vacuum bell. The routine intraoperative use of the vacuum bell was safe and effective in 131 patients. It facilitates the retrosternal dissection and the insertion of the pectus bar like other SETs. Besides a temporary mild hematoma, no relevant side effect was observed. In conclusion, an increasing number of authors report on the routine use of SET during MIRPE to improve safety of the procedure. We recommend the routine intraoperative use of the vacuum bell during MIRPE.

The Predictive Value of Haller Index in Patients Undergoing Pectus Bar Repair for Pectus Excavatum

2011 ◽  
Vol 170 (1) ◽  
pp. 104-106 ◽  
Author(s):  
Vincent E. Mortellaro ◽  
Corey W. Iqbal ◽  
Frankie B. Fike ◽  
Susan W. Sharp ◽  
Daniel J. Ostlie ◽  
...  
Keyword(s):  
Predictive Value ◽  
Pectus Excavatum ◽  
Haller Index ◽  
Pectus Bar
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