Osteoplastic procedure for correction of funnel chest

A method for osteoplastic correction of funnel chest is presented which is believed to avoid the disadvantages of previously described operations. The pros and cons of the various steps in the procedure have been discussed.     

Vascularized rib strut technique for repair of pectus excavatum.

A vascularized rib strut based on the anterior intercostal branch of the internal mammary artery was applied to provide rigid internal fixation of the chest wall after correction of pectus excavatum. The procedure is simple and has substantial advantages when compared with techniques using metallic struts or nonvascularized free rib grafts.     

Long-term result after operative correction of funnel chest

During the last decades it has been commonly accepted that funnel chest is such a serious cosmetic handicap that it deserves correction for this reason alone.     

Surgical correction of the funnel chest deformity in children

The aim of this study was to evaluate our results during and after the Nuss operation in children with pectus excavatum. We have performed the Nuss procedure in 128 patients with pectus excavatum since 2001, and 74 patients underwent bar removal. Of the 128 patients 96 were male and 32 were female; age ranged from eight to 21 years with an average of 13.8 years. In 46% of patients psychological reasons for operative treatment were dominant while in the other 54% of patients clinical signs were the indications. Complications in 128 patients included 36 pneumothorax, 28 of which resolved spontaneously. Postoperative pneumonia developed in six patients. In two patients we had infection of the implanted bar, and there were two patients with cellulitis. We had six patients with bar displacement and reoperation was needed. During the Nuss procedure we had one injury of the intercostal artery. We had pericardial tears in two patients without clinical significance. In two patients we had pericardial effusion six months after the Nuss procedure, requiring pericardiocentesis. In one patient we had fracture of the sternum. There were no complications following bar removal. After bar removal in 74 patients, 54 patients (72.9%) maintained excellent results with normal chest anatomy, good results were found in 16 patients (21.6%) with mild residual pectus and poor results in four patients (5.5%) with severe recurrence. Our experience with the Nuss procedure demonstrated excellent results with few minor complications.     

The "new" Erlangen technique of funnel chest correction - minimalization of a well working procedure

INTRODUCTION: In many operative fields there is a trend to be minimally invasive, so in chestwall surgery too. Because of this influence we developed a technique for routine measurements of the forces during surgery. So it was possible to make the Erlangen technique substantially less invasive. METHODS: Mobilisation of the sternum always begins with freeing of the xiphisternum. Then we use a spring balance with a measurement range of 20-230 N. This is attached to the sternum with a single-pronged hook, and then the sternum is raised to the desired position. DISCUSSION: Since the introduction of intraoperative measurements it has been possible to make the Erlangen technique substantially less invasive, i.e. division of the ribs at the outer rim of the funnel, previously always carried out, is no longer done. Of course we could also minimise the length of the incision.     

肋骨结构性支撑植骨在脊柱侧凸前路矫形手术中应用的长期随访

[目的]评价肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中应用的长期随访结果.[方法]回顾性分析术后随访时间超过4年的青少年特发性脊柱侧凸前路矫形手术病例30例,男3例,女27例;年龄12～ 17.5岁,平均14.3岁.侧凸类型包括PUMC Ⅰ b型5例、Ⅰc型5例、Ⅱd1型20例.全部病例均行前路矫形融合手术,植骨方式采用自体肋骨结构性支撑植骨.术前、术后及随访时摄脊柱站立位X线片,测量冠状面及矢状面Cobb角,并观察植骨融合情况,有无假关节形成及内置物并发症.[结果]随访4～10.2年,平均6.3年.融合弯冠状面矫形率术后平均为75.1％,末次随访时矫形丢失平均4.6°;固定融合节段冠状面矫形率术后平均为93.2％,末次随访时丢失平均2.1°;固定融合节段矢状面Cobb角术前与术后比较无显著性差异,末次随访时矫形丢失平均3.1°.13例胸腰段后凸患者术前后凸平均8.3°,术后矫正为前凸平均5.6°,末次随访时保持前凸平均3.7°.全部病例末次随访时均未见假关节形成或内置物并发症.[结论]肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中能获得并维持良好的冠状面及矢状面矫形,且融合率高、远期矫形丢失少,是一种可靠、有效的植骨方法.     

Minimally-invasive endoscopic correction of funnel chest deformity via an umbilical incision

Congenital funnel chest deformities (pectus excavatum) are a well known condition that may require surgical correction if repercussions on the respiratory and cardiac dynamics are caused by the compression on the mediastinal structures and by the reduction of the respiratory volume. However, the aesthetic defect may have serious psychological implications and—even if no respiratory impairment is caused—may nevertheless indicate aesthetic correction by implanting a custom-made prosthesis. Alloplastic correction traditionally results in long, visible scars. Since the presternal area is prone to hypertrophic scarring, this type of scar may be a disturbing complication of the intervention. Endoscopically-assisted minimally-invasive implantation of customized implants via an umbilical incision to introduce a customized single-unit silicone implant can avoid unsightly scarring and allows safe hemostasis in the dissection pocket, minimizing well-known side effects and patient morbidity.     

Indications and surgical technic for the correction of funnel chest and its results]

Treatment of funnel chest is only successful by surgical means. 425 funnel chest operations have been performed between 1956 and 1974 at the Surgical and Paediatric Surgical Department of the University Erlangen-Nürnberg. Different types of operative procedures have been compared with each other. The internal fixation of the elevated funnel chest with a metal strut is an operative procedure with the lowest infection rate, with less recurrences and the best anatomical and cosmetic results. The surgical procedure involves a double incision of the ribs parasternally and at the borderline of the funnel, the mobilised ventral part of the chest is elevated by a metal strut to an anatomically normal position. 235 patients have been operated on by this method. In 7% a local wound infection occured, there was one total recurrence and 15 partial recurrences. 4 years after operation 75% of the patients had an anatomically normal and well developed chest with an excellent cosmetic result.     

One-stage correction of heart defect and funnel chest in the Marfan syndrome

The first experience of simultaneous operations for heart defect and funnel chest in adult patients with the Marfan syndrome is presented. One-stage correction permits simultaneous removal the underling (valvular disease) and concomitant (laterocaudal ectopia of the heart and central vessels due to deformity of the anterior thoracic wall) causes of hemodynamic disorders. It is concluded that this policy is expedient in strictly selecting patients.     

A new surgical method for repair of funnel chest

We have devised a new surgical procedure for the repair of funnel chest deformity, which we have used in 148 of our 154 patients. The procedure involves resection of the deformed thoracic wall, including ribs and sternum, rib-sternal turnover, and anastomosis of the internal thoracic artery and veins. Several preoperative and postoperative examinations, such as bone biopsy, sternal puncture and indium chloride test, revealed definite signs of living tissue. This procedure results in minimal secondary deformity postoperatively and is indicated for adults as well as children.     

Modification of Ravitch’s operation for funnel chest with a living rib and “lapel flap”

A modified Ravitch’s operation was performed on a 15-year-old boy for funnel chest. To prevent recurrence of chest depression, fixation with the 8th rib, vascularized with the pedicled serratus anterior muscle flap, and a combined pectoralis major and rectus abdominis muscle flap, were used. The end result was satisfactory. Received: 15 January 1997 / Accepted: 4 July 1997