PECTUS EXCAVATUM REPAIR
Category: Thoracic Surgery
Abstract : Pectus Excavatum Repair : Pectus excavatum repair, also called funnel chest repair or chest deformity repair, is a type of surgery performed to correct pectus excavatum, a deformity of the front of the chest wall with depression of the breastbone (sternum) and rib (costal) cartilages. It is sometimes associaated with Marfan or Poland syndromes. The chest consists of the rib cage and sternum, w
Pectus Excavatum Repair : Pectus excavatum repair, also called funnel chest repair or chest deformity repair, is a type of surgery performed to correct pectus excavatum, a deformity of the front of the chest wall with depression of the breastbone (sternum) and rib (costal) cartilages. It is sometimes associaated with Marfan or Poland syndromes.
The chest consists of the rib cage and sternum, which protect the upper-abdominal cavity and its contents. Pectus excavatum, also called funnel chest or depressed sternum is a deformity that is usually diagnosed shortly after birth. In some people, it is not visible until they are older. The exact cause is not known, but it is believed to be due to overgrowth of the rib cartilage connected to the sternum, which results in the sternum being pushed backward toward the spine. Most people have no symptoms, but if the breastbone is pushed back far enough, heart and lung function may be affected. The purpose of pectus excavatum repair surgery is to correct the deformity to improve physical appearance, posture, and breathing.
Pectus Excavatum Repair Demographics : In the United States, pectus excavatum is the most common chest wall deformity observed in children, occurring more commonly in boys than in girls. Pectus excavatum tends to run in families. The funnel chest usually progresses as the child grows, often showing a dramatic deterioration during the puberty growth spurt.
Pectus excavatum repair is technically easiest to perform in preadolescent children, and the recovery is faster. However, almost half of the patients undergoing the operation are teenagers. Repair is rarely performed on children under eight years of age. In recent years, a large number of adults over the age of 21 years have undergone repair with equally good results as those observed with children.
Pectus Excavatum Repair Description : Pectus excavatum repair is always performed with the patient under general anesthesia. An epidural catheter is inserted for the management of pain after the operation. The surgeon makes two incisions over the sternum, on either side of the chest, for insertion of a curved steel bar or strut under the sternum. He or she proceeds to remove the deformed cartilages. The rib lining is left in place to allow renewed cartilage growth. The sternum is then repositioned, and the metal strut is placed behind it and brought out through the muscles and skin for future attachment to a brace, which will stay in place six to 12 weeks. The metal strut is fixed to the ribs on either side, and the incisions are closed and dressed. A small steel grooved plate may be used at the end of the bar to help stabilize and fix the bar to the rib. A blood transfusion is not required during surgery. The surgeon may insert a temporary chest tube to re-expand the lung if the lining of the lung is entered. A variety of surgical procedures are available to repair pectus excavatum.
Nuss procedure
A common technique is the Nuss procedure, developed in 1987 by Dr. Donald Nuss, a pediatric surgeon at Childrens Hospital of the The Kings Daughters and Eastern Virginia Medical School in Norfolk, Virginia. The procedure is minimally invasive, and results in very little blood loss and short recovery times.
Leonard procedure
Another surgical approach that drastically reduces the time required for surgery is the Leonard procedure, developed by Dr. Alfred Leonard, a Minneapolis thoracic and pediatric surgeon. This operation does not violate the chest, and is combined with a bracing technique.
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