Dynamic compression system for the correction of pectus carinatum

Martinez-Ferro, Marcelo; Fraire, Carlos; Bernard, Silvia

doi:10.1053/j.sempedsurg.2008.03.008

Cited by 124 publications

(109 citation statements)

References 16 publications

(19 reference statements)

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“…For reasons unknown, the condition is more common in males (4:1) [2]. The deformity is defined as an abnormal overgrowth of the costal cartilages, resulting in protrusion of the sternum and adjacent costal cartilages (Figure 2) [15]. PC is classified as either chondrogladiolar or chondromanubrial based on the prominent region of the sternum.…”

Section: Pectus Carinatummentioning

confidence: 99%

“…Extensive destruction of the perichondrium and rib growth centers may result in failure of further chest wall development and subsequent pulmonary hypertension, tricuspid regurgitation, and restrictive lung disease [39,40]. Furthermore, despite improvement in postoperative cosmesis, the skin incision utilized in the Ravitch procedure results in a large vertical midline chest wall scar, effectively replacing the original aesthetic concern, the pectus deformity, with a different one [2,9,15,37,41]. However, despite these complications, the Ravitch procedure was widely accepted as the gold-standard of treatment until 1998, and continues to be performed by many pediatric surgeons today.…”

Section: Old Treatment Modalitiesmentioning

confidence: 99%

“…Nevertheless, the minimally invasive nature of the Nuss procedure, the superior cosmetic outcomes, the exceedingly low mortality rate comparable to that of the Ravitch repair, and an overall complication rate similar to that of the Ravitch repair have made the Nuss technique the current preferred modality for surgical repair of pectus deformity until further large-scale prospective randomized studies comparing the two procedures suggest otherwise. [4,48]  Reduction of FVC after bar placement [47] Patients >15 years of age are at higher risk for complications [41] Dynamic Compression Bracing Custom-fitted aluminum brace assembled to form a rigid belt that surrounds the thoracic wall at the level of the defect [15]  No risk of anesthesia [15]  No visible scar [15]  No hospital admission [15]  Reduced cost to treat [15]  Skin ulceration [15]  Social discomfort [15]  Back pain [15]  Hematoma [15]  Recurrence [15]  Pressure necrosis [15]  May only remove brace when showering or playing sports [15] Patients with severe deformities require higher compression pressures, resulting in an increased complication rate [15] Vacuum Bell Suction cup applied to chest wall, creating a vacuum that sucks deformity outward [2,44]  No risk of anesthesia [44]  No risk of a major surgical procedure [44] …”

Section: Newer Treatment Modalitiesmentioning

confidence: 99%

“…The compression brace is assembled using multiple lightweight aluminum curved segments to obtain a rigid belt that surrounds the thoracic wall at the level of the defect [15]. A cushioned compression plate is attached to the anterior segment of the brace and placed at the level of the protrusion [15].…”

Section: Mini-mover Proceduresmentioning

confidence: 99%

“…A cushioned compression plate is attached to the anterior segment of the brace and placed at the level of the protrusion [15]. By pushing the sternum backward, the continuous anterior-posterior chest compression gradually reshapes the chest into a normal contour [15]. An electronic pressure measuring device is attached to the brace, permitting adjustments of the pressure to the desired level, so as to avoid inadvertent pressure necrosis and/or noncompliance due to discomfort [15].…”

Section: Mini-mover Proceduresmentioning

confidence: 99%

See 4 more Smart Citations

Advances in the management of pectus deformities in children

Swergold¹,

Sridharan²,

Loukas³

et al. 2013

OJPed

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Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these deformities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

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Section: Pectus Carinatummentioning

confidence: 99%