Combined extra-/intrathoracic correction of pectus carinatum and other asymmetric chest wall deformities : A novel technique.
OBJECTIVE
Description of a novel technique to surgically correct (asymmetric) pectus carinatum and other chest deformities using a metal bar without fixation to the ribs.


INDICATIONS
Severe thoracic deformity, extensive psychological strain, social isolation, pain and respiratory complaints. Pseudarthrosis or insufficient correction of a thoracic deformity after prior surgery. Distinctive deformities.


CONTRAINDICATIONS
Acute infections. Postoperative intrathoracic scaring in revision cases can be challenging.


SURGICAL TECHNIQUE
One-lung ventilation is used. Through two 3-4 cm long bilateral incisions to the thorax, an introducer is guided into the thorax under thoracoscopic supervision and then guided through an intercostal space out of the thorax again. A 1 cm presternal incision is performed and nylon threads are attached to the introducer bilaterally. Then the preshaped metal bar can be placed following the nylon threads. Once the metal bar is placed, the deformity is instantly corrected. Bilateral stabilizers are fixed with wire cerclage. Fixation on the ribs is not necessary.


POSTOPERATIVE MANAGEMENT
Postoperative thorax x‑ray. Intensive ventilation exercises. Implant removal after 2-3 years.


RESULTS
The technique was used in 10 primary pectus carinatum or combined pectus carinatum and excavatum deformities as well as in 6 revision cases (3 female, 13 male, age 13-32 years). Follow-up ranged from 3-15 months postoperatively. Cosmetic results were excellent. Revision surgery required in 2 patients (one rib fracture and one local implant irritation).
['Tarhan|T|T|', 'Meurer|A|A|', 'Tarhan|O|O|']
D000293:Adolescent D000328:Adult D020878:Device Removal D005260:Female D005660:Funnel Chest D006801:Humans D008297:Male D066166:Pectus Carinatum D012086:Reoperation D035441:Thoracic Wall D016896:Treatment Outcome D055815:Young Adult
Thorax Bone diseases, developmental Costal cartilage Minimally invasive surgery Sternum