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PubMed2003

[Funnel chest. New aspects since introduction of a minimally invasive surgical technique].

For many years, a variety of open surgery techniques represented the "golden standard" for remodeling the chest wall of patients with pectus excavatum. This situation changed when a minimally invasive approach was first introduced by D. Nuss (minimally invasive repair of pectus excavatum--MIRPE). This procedure was originally developed only for children and is based on the fact that the growing chest wall is still flexible. The indication for MIRPE is identical for both open surgery and the minimally invasive procedure. The new technique is gaining acceptance worldwide in the field of pediatric surgery, and older patients who resist open surgery for correction of their pectus excavatum now request the new and less invasive procedure. Most of them found their information via the Internet and it is noteworthy that patients, or their parents, are now looking differently at the indication for repairing pectus excavatum.

Aged↗
PubMed1978

[Surgical treatment of funnel chest].

The main problems of indication, operating techniques and results are recalled after 39 cases of pectus excavatum (P.E.) operated on 74 followed up children. Analysis revealed frequent family trend, respiratory past records of Marfan's morphological type and intrathoracic spur. Sternochondroplasty had varied stabilizing ways : first Garnier's technique, then Judet's costal clips, today the mediastinal rod of Morel. The relative deterioration of morphological results depended on the reliability of the manner of fixing. For good results, neither age, sex, nor the importance of the retraction interfered. The unfavourable elements are the gently sloping thorax and associated vertebral manifestation.

Child↗
PubMed1992

[Surgical treatment of funnel chest].

Fourty one patients (33 males and 8 females) with pectus excavatum were operated by Ravitch method modified by Politowski or Drews (36 cases and 5, respectively) from 1980 to 1989. The age of patients ranged from 5 to 25 years (mean 11 years), they were operated because of cosmetic reasons exclusively. Twenty nine of them reappeared to be examined after follow up of 15 months to 10 years (mean 3.5 years). Subjective opinion of the patient, clinical examination and radiological appearance were taken into consideration. There were 72.5% of excellent and good results. No recurrence of the deformity was observed, the most suitable age for the surgery is from 8 to 10 years.

Adolescent↗
PubMed1985

[Long-term result of the surgical treatment of funnel chest by Jung's method. Apropos of 32 cases].

A homogeneous series of 32 cases of pectus excavatum were treated by Jung's method of reversal of the breast-plate pedicle. Operation was usually performed at about puberty. The mortality is nill for this technique, which is simple and which, for a low morbidity, provides good functional and esthetic results in 87% of cases. Follow up examinations after 4 to 18 years in 26 patients showed maintenance of results and the absence of any case of recurrence. This confirms the pathogenic hypothesis suggested by the authors in 1972. By performing a true laparoplasty in addition to the sternum reversal, this operation corrects disorders of ventilatory mechanics at the origin of the deformity.

Adolescent↗
PubMed1978

[Respiratory and hemodynamic functional tests in funnel chest].

Fifty three patients with Pectus excavatum, 12.5 years of age on average, were studied. They frequently had respiratory history (in 36% of cases): asthma, repetitive bronchites or rhinopharyngites, and associated squeletal deformities (17%) : kyphoscoliosis, lordo-kyphosis and scoliosis. As far as ventilation is concerned, the restrictive syndrome was found in 49% of cases, severely in 23% (20% decrease in C. V.) An obstructive syndrome was found only in cases of associated asthma. Bodypletysmography done parallely in 5 cases puts in evidence or increases the ventilatory abnormalities. In the cardio-vascular check up, the chest X ray, E.C.G., the pulmonary scintigraphy or straight microcatheterization, usually reveal some abnormality (15% of cases). The synthesis of results points out two facts : 1) when the heart is in its position and the cardiomediastinal shadow enlarges, the E.C.G. abnormalities are unimportant; when the heart is displaced towards the left, the electrical disorders are bigger ; 2) microcatheterization done on 22 subjects revealed a gradient of systolic pressure, right ventricle-pulmonary artery, definite or severe in 4 cases, lesser in 9. Surgery rarely improves the spirometry and E.C.G. abnormalities, but does seem to cure the hemodynamic disorders.

Adolescent↗
PubMed1990

[Status of the myocardium and heart valves in funnel chest].

Examinations of 70 patients with keeled deformation of the chest (KDC) have revealed signs of connective tissue dysplasia in all the examinees, as well as heart rhythm and conduction disorders. Echography has shown ventricular and atrial septal defects, mitral valve prolapse, dilatation of the aortic root, tricuspidal valve prolapse, abnormally located chorda. The development of KDC in the presence of external connective tissue stigmata, involvement of the cardiovascular system, changed dermatoglyphic pattern of the palms and fingers (as evidenced by dermatoglyphic analysis), as well as findings of histologic examinations of the cartilage removed in the course of thoracoplasty may indicate a generalized abnormality of the connective tissue in this patient population and KDC may be regarded as one of its manifestations.

Abnormalities, Multiple↗
PubMed2006

Breast radiotherapy in women with pectus excavatum (funnel chest): is the lateral decubitus technique an answer? A dosimetric study.

Breast radiotherapy is a technical challenge in women with pectus excavatum. We aim to assess isocentric lateral decubitus (ILD) technique as a means to irradiate breasts for patients with pectus excavatum. Four women presenting with left-sided breast cancers and found to have pectus excavatum were offered breast-conserving treatments. Post-operative breast radiotherapy was indicated (50 Gy) in two patients, with an additional boost to the tumour bed (16 Gy). Both ILD and supine techniques were simulated. We report the dosimetric comparison of these techniques and the acute skin toxicity of ILD radiotherapy. ILD permitted the same breast dose-homogeneity as the supine technique while decreasing breast thickness by 4.5-6.8 cm. The width of lung and/or heart receiving > 20 Gy ranged between 2.1 cm and 4.3 cm with the supine technique and between 0.5 cm and 1.1 cm with ILD. The estimated percentage of ipsilateral lung receiving > 20 Gy ranged from 21% to 34% with the supine technique and from 0% to 5% with ILD. Acute skin toxicity was scored 1 for all patients at completion of ILD radiotherapy. ILD is an effective breast radiotherapy technique for patients with pectus excavatum that preserves the underlying heart and lung from unnecessary toxicity.

Adult↗
PubMedDate not supplied

[Changes in the structure of type I collagen and cross-links between type I and type III collagen chains in a patient with funnel chest].

Skin and rib cartilage collagens were studied in patient 1.I.K. with isolated form of pigeon chest as well as in a group of children without any impairments of connective tissue. Distinct decrease in stability of collagen I, an increase in the ration of alpha 1 (I)/alpha 2(I) chains and impairment in formation of beta 12 dimers were detected in the patient with pigeon chest. In the patient skin total ratio between collagens I and III, calculated from a content of BrCN-peptides, was similar to normal level, whereas the proportion was markedly increased between intact molecules of collagens III and I free of cross-links, which was calculated from the ratio of alpha 1(III)/alpha 2(I) chains. Presence of cross-links between alpha 1 (III) and alpha 2 (I) chains as well as between alpha 1 (III) and alpha 2 (I) chains was detected after peptide mapping of polypeptides arranged in the region of beta 11 and beta 12 dimers. All the collagen I preparation, extracted from skin of the patient 1.I.K., contained molecules with unstabilized N-terminal sites. These results suggest that mutation occurred in the N-terminal region of alpha 1(I) chain. Analysis of collagen from the patient 1.I.K. rib cartilage demonstrated a slight decrease in total stability of collagen II as well as elevated concentration of collagen II molecules containing unstabilized N-terminals. Mechanisms responsible for formation of cross-links between polypeptide chains of collagens I and III detected in human skin are discussed.

Cartilage↗
PubMed2004

Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children.

Surgical correction of pectus excavatum in children has gained new momentum since the introduction of the new minimally invasive repair by Nuss. To date, no studies directly evaluate the outcome of the new technique versus that of the conventional technique. From 2000 to 2002, 28 patients underwent pectus excavatum correction in the authors' hospital. Twenty-one were treated by minimally invasive repair of pectus excavatum and seven patients had open correction. Intraoperative and postoperative complications, clinical outcome, and patient satisfaction were evaluated. In the minimally invasive repair of pectus excavatum group, the children were younger (14.4 +/- 2.9 versus 17.8 +/- 3.2 years), had shorter operation times (53 +/- 18 versus 125 +/- 6 minutes), and had less blood loss (minimal versus 380 +/- 175 ml). No intraoperative complications were recorded. In the conventional group, two pleural lacerations occurred. Early postoperative complications in the minimally invasive repair group included two pneumothoraces and one case of pleural effusion. In the conventional group, one pneumothorax and one case of pleural effusion occurred. Late postoperative complications in the Nuss group included one costal erosion, two bar dislocations, one severe wound infection requiring bar removal, one hematothorax, and one case of postpericardiotomy syndrome; in the conventional group, there was one severe wound infection. In both groups, the patients rated their cosmetic results as good to very good. Minimally invasive repair of pectus excavatum is a novel method with clear advantages, such as limited surgical trauma and small scars. The high rate of postoperative complications may decrease with growing experience in the future. In well-selected patients (age, symmetric deformity), the Nuss procedure may become the method of choice. However, there is still a lack of long-term follow-up.

Adolescent↗
PubMed1990

[Plastic surgery of the thoracic wall (malformations and tumors) using a sliding splint-stapler].

Chest wall instability, created surgically by correction of a chest deformity (funnel chest or, more rarely, pigeon chest) or by resection of a tumour of the chest wall, is serious as it can jeopardize the immediate vital prognosis because of paradoxical respiration and, in the long term, the functional and aesthetic prognosis due to progressive impaction of the unstable segment of the wall. The polyvalent and adaptable material which we have developed (sliding splint-staple) and which we also use in thoracic traumatology (thoracic flaps), has allowed us to perform audacious corrections for deformities or wide resections for tumours since 1980. We have used this material on 13 occasions for contention after sternochrondroplasty, with an excellent result in each case both in terms of the immediate stability and in terms of the aesthetic result. The sliding splint-staples, generally two, are placed in staggered positions behind the sternum (11 cases--funnel chest) or in front of the sternum (2 cases--pigeon chest). The material is left in place for at least one year. We have used this material on 8 occasions after various tumour resections: 3 times after subtotal resection of the sternochrondral breastplate and 5 times after lateral or anterolateral resection removing at least 2 ribs.

Adult↗
PubMedDate not supplied

Pectus excavatum breast and chest deformity: indications for aesthetic plastic surgery versus thoracic surgery in a multicenter experience.

BACKGROUND: Breast and chest wall disfiguration attributable to a funnel chest is an aesthetically and sometimes functionally debilitating deformity requiring surgical correction. Whereas extensive and combined deformities of the ventral chest wall are classically corrected using a so-called minimally invasive repair of the pectus excavatum, a modified Ravitch repair, or the minimized Erlangen repair, plastic surgeons are mostly challenged with alloplastic implant corrections of mild funnel chests. The authors have introduced an endoscopic method for placement of customized implants to restore the visible and nonfunctionally disturbing deformation of mild funnel chests when only the sternal plate is involved. This study compared these different plastic surgical and thoracic surgical approaches in a multicenter experience to develop a clinical algorithm and to identify those patients not requiring bony correction but rather alloplastic endoscopic implant correction alone. METHODS: Patients with deformed rib cages and sternal plates were treated with the Erlangen minimally invasive procedure or a modified Ravitch procedure. For deformities involving the sternal bones only, endoscopically assisted minimally invasive implantation of silastic implants was performed. RESULTS: Between 1987 and 2003, 599 patients with a pectus excavatum deformity were treated surgically by the authors' group. Between 1999 and 2003, 515 patients underwent surgery using the Erlangen minimally invasive repair technique at Friedrich-Alexander University-Erlangen. In addition, 84 patients underwent surgery at the Freiburg University Medical Center. In the current series, 79 patients underwent surgery using the modified Ravitch method. The mean patient age was 20.5 years (range, 3-54 years), and the rate of postoperative relapses was 5%. The findings showed that 73% of the patients judged the aesthetic result as excellent to good, and 20% were satisfied. In contrast, only five patients were suitable for soft tissue augmentation only. Two of these patients in the initial period received custom implants presternally via classical transverse skin incisions, whereas three patients were treated with endoscopic customized implant tissue augmentation. CONCLUSION: Whereas with combined deformity of the sternal plate and the rib cage, a modified Ravitch repair yields good results, the endoscopic soft tissue correction with customized implants helps to avoid unsightly scars, allows for safe hemostasis in the dissection pocket, and leads to enhanced patient satisfaction. In the case of major chest wall deformity with orthopedic and functional relevance, a combination of the minimally invasive procedures (e.g., endoscopic correction and Erlangen repair) seems to show both optimized cosmetic results and maximized functionality.

Adolescent↗
PubMed1993

[Remote thermography in funnel-shaped chest deformity in children].

Examined were 47 children with a funnel-shaped chest deformity and 18 healthy children (control group) ranging in age from 2 to 14 years. Thermal fields of the chest and hands were registered. New data characterizing the degree of pronouncement of chest deformity and heart shift were obtained. In patients with bronchopulmonary diseases, the areas of hyperthermia corresponding to inflammatory process location were noted. Thermography of the hands permitted, to obtain the data characterizing the pronouncement of respiratory failure.

Adolescent↗
PubMed1998

Long-term results after correction of anterior chest wall deformities.

BACKGROUND: Surgical correction of pectus deformities was mainly performed for cosmetic and psychologic reasons but eventual cardiopulmonary symptoms improved. Whether this results from alterations in cardiopulmonary physiology is still controversial METHODS: In 25 years 662 patients underwent correction (390 for pectus excavatum-funnel chest, 235 for pectus carinatum-chicken chest, 37 for pectus arcuatum-pouter pigeon chest). Surgical correction was mainly performed for cosmetic and psychologic reasons. Sternochondroplasty was performed without prosthetic material RESULTS: Clinical results for funnel chest were satisfactory in 83.6% (excellent 44.1%, good 39.5%) and were always good for protrusion deformities if enough deformed cartilages were resected. In a retrospective study the pulmonary function tests performed on 152 patients with funnel chest before surgery and at long-term follow-up demonstrated an eventual increased restriction at follow-up, despite symptomatic improvement and increased anteroposterior chest diameter on the X-ray, but restricted anterior chest wall motion. In a prospective study the exercise cardiorespiratory function tests on 35 patients with funnel chest before and one year after operation suggested unchanged work performance, but an increased oxygen consumption and acidification due to a higher work of breathing after operation, caused by decreased chest wall compliance. CONCLUSIONS: The subjective physical improvement after operation cannot be explained by changes in static lung volumes or in cardiorespiratory function at exercise, but is due to other unexplained factors. Satisfactory subjective long-term results of most patients justify surgical correction. Both physical as well as psychologic and cosmetic factors may allow operative correction.

Adolescent↗