Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum

A Next-Generation Pectus Excavatum Repair Technique: New Devices Make a Difference

“…The technique included use of a stabilizer in the early period and then multipoint pericostal suture fixation since 2001. In 2007, we developed a new device, the claw fixator, which enables fixation of the pectus bar to the rib not by suturing but by hooking with a metal blade that prevents bar flipping (type 1 and 2 bar displacement) [10]. In 2009, we developed a hinge plate to prevent intercostal muscle stripping (type 3 bar displacement) [10] by supporting the hinge points.…”

“…In 2007, we developed a new device, the claw fixator, which enables fixation of the pectus bar to the rib not by suturing but by hooking with a metal blade that prevents bar flipping (type 1 and 2 bar displacement) [10]. In 2009, we developed a hinge plate to prevent intercostal muscle stripping (type 3 bar displacement) [10] by supporting the hinge points. To compare the results of each fixation technique, patients were divided into four groups: a stabilizer group (STB, n ¼ 180); a multipoint pericostal suture fixation group (MPF, n ¼ 760), a claw fixator group (CFT, n ¼ 699); and a claw fixator plus hinge plate group (CFTþHP, n ¼ 177).…”

“…We performed in-depth studies of how the pectus bar dislocates, and derived three mechanisms of bar displacement [10]. We recognized that secure bar stabilization can be achieved by fixing the bar against multiple directional forces, and then determined how to block the displacements in the various directions.…”

Revision of failed, recurrent or complicated pectus excavatum after Nuss, Ravitch or cardiac surgery

“…Failure or recurrence after primary MIRPE repair is generally due to technical issues and includes (2,(5)(6)(7)(8):…”

“…Adequate stability is also impacted by the number of bars and balance of the chest wall on support structures. The pressure required to elevate the chest is significant and an inadequate number of bars to support the chest anterior can lead to lateral stripping of the intercostal and increased risk of bar rotation (8,10,12,13). Recommendations as to what is an adequate number of bars varies (2,(14)(15)(16).…”