912 open XXXX repairs: changing trends, lessons learned: one surgeon's experience.

@entity1 @entity308 @entity1353 @entity260 @entity7405 @entity591 @entity158 @entity1408
BACKGROUND: Severe @entity1408 ( @entity1408 ) is common, often causing physiologic impairment. Inconsistent results have been reported using a variety of open surgical techniques with extensive subperiosteal costal cartilage resection. METHODS: Since 1969, 912 (80% @entity1 ) symptomatic @entity1408 @entity1 (mean severity index 4.9) underwent open surgical correction at UCLA Medical Center by one surgeon. Almost all @entity1 had @entity1353 , reduced endurance, @entity7405 , and @entity591 with exertion. The mean age at operation was 19.8 years. @entity308 was present in 465 (51%) @entity1 ; combined @entity1408 and pectus carinatum was present in 33 @entity1 . Recurrent @entity1408 were repaired on 73 @entity1 . Progressively less deformed costal cartilage was resected during the 38-year period; almost all of the last 303 @entity1 had only short segments excised from both ends with suture reattachment. Transverse wedge sternal osteotomy was used on all @entity1 , and 883 (97%) had a sternal support strut for 6 to 9 months. RESULTS: @entity1353 , endurance, @entity7405 , and @entity591 was improved in almost all @entity1 within 5 months after repair. Repair for recurrent deformities and resection of mild localized cartilage protrusion was reduced more than threefold when minimal cartilage resection with wire reattachment was used. @entity260 in the last 537 @entity1 were less frequent, @entity158 was less severe, and results were better than when more extensive previous repairs were used (mean follow-up 7.6 years). Very good or excellent results were reported by 94.2% of all @entity1 . CONCLUSIONS: In this largest series of open @entity1408 repair, progressively less extensive operative techniques have resulted in low morbidity, mild @entity158 , short hospitalization, and very good physiologic and cosmetic results.
