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Pectus excavatum

A 10-year review of a minimally invasive technique for the correction of pectus excavatum

Nuss D, Kelly RE Jr, Croitoru DP, Katz ME.

 1998 Apr;33(4):545-52.

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Abstract


Pectus excavatum

A 10-year review of a minimally invasive technique for the correction of pectus excavatum

Nuss D, Kelly RE Jr, Croitoru DP, Katz ME.

 1998 Apr;33(4):545-52.

PURPOSE:

The aim of this study was to assess the results of a 10-year experience with a minimally invasive operation that requires neither cartilage incision nor resection for correction of pectus excavatum.

METHODS:

From 1987 to 1996, 148 patients were evaluated for chest wall deformity. Fifty of 127 patients suffering from pectus excavatum were selected for surgical correction. Eight older patients underwent the Ravitch procedure, and 42 patients under age 15 were treated by the minimally invasive technique. A convex steel bar is inserted under the sternum through small bilateral thoracic incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over, thereby correcting the deformity. After 2 years, when permanent remolding has occurred, the bar is removed in an outpatient procedure.

RESULTS:

Of 42 patients who had the minimally invasive procedure, 30 have undergone bar removal. Initial excellent results were maintained in 22, good results in four, fair in two, and poor in two, with mean follow-up since surgery of 4.6 years (range, 1 to 9.2 years). Mean follow-up since bar removal is 2.8 years (range, 6 months to 7 years). Average blood loss was 15 mL. Average length of hospital stay was 4.3 days. Patients returned to full activity after 1 month. Complications were pneumothorax in four patients, requiring thoracostomy in one patient; superficial wound infection in one patient; and displacement of the steel bar requiring revision in two patients. The fair and poor results occurred early in the series because (1) the bar was too soft (three patients), (2) the sternum was too soft in one of the patients with Marfan's syndrome, and (3) in one patient with complex thoracic anomalies, the bar was removed too soon.

CONCLUSIONS:

This minimally invasive technique, which requires neither cartilage incision nor resection, is effective. Since increasing the strength of the steel bar and inserting two bars where necessary, we have had excellent long-term results. The upper limits of age for this procedure require further evaluation.

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Pectus carinatum

A 5-year experience with a minimally invasive technique for pectus carinatum repair

Abramson H, D'Agostino J, Wuscovi S

 2009 Jan;44(1):118-23

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Abstract


Pectus carinatum

A 5-year experience with a minimally invasive technique for pectus carinatum repair

Abramson H, D'Agostino J, Wuscovi S

 2009 Jan;44(1):118-23

PURPOSE:

This report describes a 5-year experience with a novel, minimally invasive surgical technique for treatment of pectus carinatum.

METHODS:

From June 2002 to August 2007, 40 patients underwent operation to correct pectus carinatum by pressure applied through a curved steel bar that was placed subcutaneously anterior to the sternum, via lateral thoracic incisions. The bar is inserted through a polyvinyl chloride tube with the convexity facing posteriorly. The polyvinyl chloride tube is positioned presternally by trocar. Subperiosteal wires attach small fixation plates to the ribs laterally, and the convex bar is secured to the small fixation plates with screws applying manual pressure to the anterior chest wall until the desired configuration is achieved. The compressive elongated bar is attached to the fixation plate with screws. The average age was 14.3 years (range, 10-21 years), and 90% were male. Both symmetric and asymmetric protrusions were treated. Patients whose chest was not malleable, and whose sternum could not be brought to a desirable position with pressure from the operator's hand, were treated by the open or "Ravitch" technique. After 2 or more years, the bar, wires stitches, screws, and fixation plates were removed.

RESULTS:

Of 40 patients treated with this procedure, 20 have undergone bar removal with the following results: 10 excellent, 4 good, 4 fair, and 2 poor. Average blood loss was 15 mL. Average length of hospital stay was as follows: implant, 3.8 days; removal, 1.4 days. Patients returned to routine activity 14 days after repair. Average follow-up since primary repair is 2.49 years. In those who have had bar removal, it is 1.53 years. Complications were pneumothorax in 1 patient, treated with chest tub e suction; skin adherence in 8 cases; seroma in 6; wire breakage in 3; persistence of pain in 1; and infection in 1. Technical modifications (selecting younger patients, excluding patients with a stiff thoracic wall, submuscular insertion of the bar, stronger pericostal wire) have been associated with no complications in the last 16 cases.

CONCLUSIONS:

This experience with a new, minimally invasive technique for the treatment of pectus carinatum shows it to be safe and effective. The correction obtained was highly satisfactory with minimal complications. It should be considered in appropriate cases as an alternative to more invasive techniques.

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Tumors

Thoracic wall reconstruction with bioabsorbable plates in pediatric malignant thoracic wall tumors

Guillén G, García L, Marhuenda C, Pellisé F, Molino JA, Fontecha CG, López S, Lloret J

 2016 Aug 3

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Abstract


Tumors

Thoracic wall reconstruction with bioabsorbable plates in pediatric malignant thoracic wall tumors

Guillén G, García L, Marhuenda C, Pellisé F, Molino JA, Fontecha CG, López S, Lloret J

 2016 Aug 3

AIM:

Childhood malignant chest wall tumors may require extensive surgical resection and reconstruction with musculoskeletal flaps or non-resorbable prosthetic materials. Implant-related complications and scoliosis often occur. This study analyzes the outcomes of chest wallreconstruction using resorbable plates as an alternative approach.

METHODS:

Retrospective review (2007-2015) of patients who underwent resection of malignant primary chest wall tumors in 2 tertiary pediatric centers. Reconstruction was performed using copolymer (l-lactic and glycolic acid) plates, fixed to the ribs and surrounding structures with copolymer screws and/or polyglactin sutures.

RESULTS:

Eight patients aged 10.6+2.6years were treated. There were no operative complications, and implant removal was not required in any case. Six patients received postoperative radiotherapy. Over follow-up (39.6months, range 9.4-78), chest wall shape was maintained in all, and there were no radiological artifacts. Three patients developed scoliosis (Cobb 17°-33°), but treatment was needed only in one, who had undergone hemivertebrectomy. There were no cases of local tumor relapse. One patient died because of metastatic spread.

CONCLUSIONS:

Implantation of bioabsorbable l-lactic and glycolic acid copolymer plates with a relatively simple technique provided a rigid, stable reconstruction with only mild mid-/long-term complications. Resorbable plates may be a good alternative for pediatric chest wallreconstruction.

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