Nuss Procedure for Pectus Excavatum: A Comparison of Complications Between Young and Adult Patients

Loos, Erik R. de; Pennings, Alexander J.; Roozendaal, Lori M. van; Daemen, Jean H. T.; Gool, Matthijs H. van; Lenderink, Timo; Horck, Marieke van; Hulsewé, Karel W. E.; Vissers, Yvonne L. J.

doi:10.1016/j.athoracsur.2020.10.017

Cited by 24 publications

(22 citation statements)

References 24 publications

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“…A retrospective cohort study of adolescents and young adults who underwent the Nuss procedure showed that some of them suffered from chronic postsurgical pain [11]. In our clinical practice, we also observed that some children still complained about pain six months postoperatively.…”

Section: Introductionsupporting

confidence: 54%

Patient-Controlled Intravenous Analgesia with or without Ultrasound-Guided Bilateral Intercostal Nerve Blocks in Children Undergoing the Nuss Procedure: A Randomized, Double-Blinded, Controlled Trial

Sun

Hao

et al. 2022

Pain Research and Management

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Background. Two analgesic strategies have been described for pain treatment after the pectus excavatum surgery: the patient-controlled intravenous analgesia (PCIA) and ultrasound-guided intercostal nerve block. In this prospective, randomized and double-blinded trial and the short and long-term outcomes were compared in patients after surgery. Methods. The children were randomized to either the intercostal or control group. Ultrasound-guided intercostal nerve block was with 0.25% ropivacaine and 5 mg dexamethasone in the intercostal group, while the control group was with 0.9% normal saline. The block was performed in the intercostal space corresponding to the lowest depression of the sternum and repeated bilaterally in the spaces above and below. Postoperatively, the children in the two-groups received PCIA with fentanyl for 48 hours. The primary outcome was a pain score on the postoperative day 1, as measured by the Visual Analogue Scale (VAS). Results. Sixty children undergoing the Nuss procedure were enrolled in the trial. The mean differences in VAS scores between the two groups were 3.2 in the PACU ( p < 0.001 ), 1.7 on postoperative day 1 ( p < 0.001 ) and 0.7 on postoperative day 2 ( p = 0.015 ). The opioid consumption was significantly lower in the intercostal group during the postoperative 48 hours ( p < 0.05 ). The anxiety and QOL scores in the intercostal group were significantly improved on some points of time ( p < 0.05 ). The incidence of adverse events was markedly lower in the intercostal group during the postoperative 48 hours ( p < 0.05 ). Conclusions. Our results suggest ultrasound-guided intercostal nerve block with PCIA may be more effective than PCIA alone in children who underwent the Nuss procedure.

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Section: Introductionsupporting

confidence: 54%

Patient-Controlled Intravenous Analgesia with or without Ultrasound-Guided Bilateral Intercostal Nerve Blocks in Children Undergoing the Nuss Procedure: A Randomized, Double-Blinded, Controlled Trial

Sun

Hao

et al. 2022

Pain Research and Management

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“…The culture methods included smear identification of common bacteria and fungi, culture and drug sensitivity test of common bacteria and fungi, culture and drug sensitivity test of anaerobic bacteria and aerobic bacteria, and culture within 2 h after collection. (2) The gap between the internal fixator and the tissue was flushed with a 50-ml syringe with a needle, and a large amount of normal saline, 3% hydrogen peroxide, and 2.5% iodophor was repeatedly flushed to scratch the wound surface to remove the necrotic/infected tissue. (3) The wound was soaked with 2.5% iodophor solution for 10-15 min.…”

Section: Debridementmentioning

confidence: 99%

“…The Nuss Technique has been recognized by pediatric surgeons for its advantages, such as small trauma, short operative time, and small incision, and has become the mainstream surgical method at present. 2 Chicken breast is also known as boat chest or pigeon chest. Different from funnel chest, most patients with chicken breast have no obvious clinical symptoms, and the purpose of seeking medical treatment is to improve their appearance.…”

Section: Introductionmentioning

confidence: 99%

“…The depression of the chest wall compresses the viscera, and the abnormal appearance of the chest has a serious impact on the physiology and psychology of the patient. The Nuss Technique has been recognized by pediatric surgeons for its advantages, such as small trauma, short operative time, and small incision, and has become the mainstream surgical method at present 2 . Chicken breast is also known as boat chest or pigeon chest.…”

Section: Introductionmentioning

confidence: 99%

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The application of local rotating flap and latissimus dorsi flap in thoracic deformity correction

Zhang

Yang

Wang

et al. 2021

J of Cosmetic Dermatology

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Background:Wound healing problem is one of the main complications after correction of chest wall deformity. Orthopedic flap tissue repair technique has a clear significance in non-healing wound and defect wound and provides a new choice for poor wound healing after orthopedic surgery of chest wall deformity.Objective: To investigate, the application value of modified local rotary flap and latissimus dorsi myocutcutaneous flap in the treatment of poor wound healing after orthodontic treatment of chest wall deformity. Method:A retrospective analysis was performed on patients who admitted to our department from August 2012 to November 2019 due to non-healing incision after surgery for thoracic deformity. Skin flap was selected according to the size of the wound surface, and the effect of skin flap repair was observed. The clinical data of the included patients were recorded, and the preoperative and postoperative wound conditions were evaluated.Results: This study included 13 patients with chest wall deformity who received plastic surgery tissue using flap technique for wound repair, 11 cases used modified local rotation skin flap, and 2 cases used modified latissimus dorsi myocutaneous flap. The mean age of the 13 patients was 18.54 ± 4.14 years old, the mean body mass index (BMI) was 17.02 ± 2.16 kg/m 2 , and the mean preoperative nonunion time of the incision was 64.77 ± 93.01 days. Five patients had positive bacteria culture on the wound surface, including 3 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, and 1 case of Staphylococcus epidermidis. All the 13 patients achieved primary grade A healing. Conclusion:The modified local rotary flap and latissimus dorsi musculocutaneous flap have a significant effect on the postoperative correction of chest wall deformity, which can ensure wound healing while retaining the orthopedic plate to the maximum extent to ensure the effect of the correction.

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“… 3 A considerable proportion of PE patients choose surgical intervention in adulthood or even lifelong follow-up without surgery. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Academic performance in children with pectus excavatum: a real-world research with propensity score matching

Fan

Kong

et al. 2023

Ther Adv Respir Dis

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Background: The optimal timing of surgery for pectus excavatum (PE) is controversial. A large proportion of children will not undergo surgery before puberty. However, untimely surgery may lead to a decline in the children’s social adaptation and competitiveness because the children have already developed psychological and physiological impairments due to PE at an early age. The study retrospectively compared the academic performance in PE children undergoing the Nuss procedure versus nonsurgical observation. Methods: This retrospective real-world research study included 480 PE patients with definite surgical indications, in whom it was first recommended that they undergo surgery between the ages of 6 and 12 years old. Academic performance was collected at baseline and 6 years later. A generalized linear regression was calculated to screen the factors affecting the performance. A propensity score matching (PSM) analysis was conducted to reduce the potential for confounding factors between surgical and nonsurgical PE patients. Results: Haller index (HI) and pulmonary function were recognized as factors affecting baseline performance according to the generalized linear regression. For PE children with surgical indications, their academic performance significantly declined after 6 years of nonsurgical observation (52.1% ± 17.1% versus 58.3% ± 16.7%, p = 0.042). The academic performance in the surgery group was better than that in the nonsurgery group 6 years after PSM (60.7% ± 17.7% versus 52.1% ± 17.1%, p = 0.008). Conclusions: The severity of PE will affect the academic performance of children. For PE children with definite surgical indications between the ages of 6 and 12 years old, surgical intervention rather than nonsurgical observation is more conducive to the development of children’s academic performance.

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Nuss Procedure for Pectus Excavatum: A Comparison of Complications Between Young and Adult Patients

Cited by 24 publications

References 24 publications

Patient-Controlled Intravenous Analgesia with or without Ultrasound-Guided Bilateral Intercostal Nerve Blocks in Children Undergoing the Nuss Procedure: A Randomized, Double-Blinded, Controlled Trial

Patient-Controlled Intravenous Analgesia with or without Ultrasound-Guided Bilateral Intercostal Nerve Blocks in Children Undergoing the Nuss Procedure: A Randomized, Double-Blinded, Controlled Trial

The application of local rotating flap and latissimus dorsi flap in thoracic deformity correction

Academic performance in children with pectus excavatum: a real-world research with propensity score matching

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