The operative treatment of pectus excavatum

Ravitch, Mark M.

doi:10.1016/s0022-3476(56)80075-9

Cited by 112 publications

(121 citation statements)

References 4 publications

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“…Previous surgical strategies for correction of funnel chest deformities consisted of serial trans-section of rib cartilage and horizontal mobilization of the sternum [6]. Dr. Donald Nuss proposed a strategically very different approach consisting of outward bending of the pectus by means of a steel bar without mobilization of the skeleton and thus, a correction method aiming at the remodeling of the involved bones and cartilages over time [1].…”

Section: Discussionmentioning

confidence: 99%

Early complications of the Nuss procedure for pectus excavatum: a prospective study

et al. 2008

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The Nuss procedure is a minimally invasive method for the correction of pectus excavatum, with several centers reporting its successful application. Complications related to the Nuss procedure are not uncommon and life-threatening complications have been reported. This study focuses on the incidence and management of complications in a series of 167 children and adults with funnel chest corrected by Nuss procedure. Guidelines and strategies to avoid the most common and typical complications are proposed. All patients with funnel chest, operated between April 2000 and 2006 were evaluated prospectively. Our surgical approach involved the submuscular insertion of the pectus bar under right-sided thoracoscopic control. The bar was secured in most cases with one stabilizer on the right side on the underlying rib to prevent bar displacement. Postoperative pain was primarily managed by epidural catheters. All data in the patient report forms was prospectively entered in a database. All complications were documented and classified into major or minor complication. A major complication was noted, if an organ injury occurred or if a significant surgical intervention became necessary. A minor complication was documented, if either an endoscopy or an evacuation of fluid or gas from the thorax by puncture were necessary. One hundred and sixty seven patients (136 males and 31 females) with a mean age of 16.3 (range 5-40 years) were included in this study. Major complications occurred in seven patients (4.2%) and consisted of one intraoperative heart perforation, one piercing of the liver with the trocar, bar infections (n = 2) and significant bar displacement (n = 3). Minor complications were seen in 122 patients (73.1%) and consisted of breakage of wires used to secure the lateral stabilizer plate (n = 48), pleural effusions (n = 28), intraoperative rupture of the intercostal muscle (n = 15), pericardial tears without clinical significance (n = 7) and lung atelectasia (n = 4). Major complications related to the Nuss procedure were rare but preventable and could mainly be attributed to the learning curve. Most minor complications can be avoided by changing the technique, e.g. fixation of the bar and the stabilizer onto the underlying rib, use of PDS cords instead of metal wires to fix the bar and the stabilizer, entrance into and exit of the thorax medial to the rim of the pectus excavatum, etc. Some complications are related to the technique, such as minor pleural effusion or remaining gas in the thorax. Clear guidelines in regard to the technique are presented to prevent the majority of complications and thereby shorten the learning curve.

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Section: Discussionmentioning

confidence: 99%

Early complications of the Nuss procedure for pectus excavatum: a prospective study

et al. 2008

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“…The method according to Ravitch including its numerous modifications [14][15][16][17][18][19][20] competes with the newer method according to Nuss [21]. The discussion is intense especially regarding minimal invasiveness, complications, and relapses [39].…”

Section: Visual Analogue Scale Excellent------------------mentioning

confidence: 99%

Patient satisfaction and clinical results 10 years after modified open thoracoplasty for pectus deformities

Funk

Groß

Placzek

2011

Langenbecks Arch Surg

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“…Sternal elevation or turnover has been the standard procedure for the treatment of pectus excavatum [2,6,8]. However, the operation is more complicated in older patients than in younger ones.…”

Section: Discussionmentioning

confidence: 99%

“…Pectus excavatum has usually been corrected with sternal elevation or sternal turnover [2,6,8]. The preschool years are the optimum time for this type of surgery, as it is technically difficult and more invasive to correct the condition in adults.…”

Section: Introductionmentioning

confidence: 99%

Correction of pectus excavatum with free latissimus dorsi musculocutaneous flap

Komuro

Masuda

Kobayashi

et al. 1999

European Journal of Plastic Surgery

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The treatment of pectus excavatum in an adult patient using a free de-epithelialized latissimus dorsi myocutaneous flap is described. While sternal elevation has been a standard method for the treatment of pectus excavatum, the procedure proposed herein is an appropriate option for patients with mild pectus excavatum who want to avoid invasive surgery and return to daily activities as soon as possible.

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The operative treatment of pectus excavatum

Cited by 112 publications

References 4 publications

Early complications of the Nuss procedure for pectus excavatum: a prospective study

Early complications of the Nuss procedure for pectus excavatum: a prospective study

Patient satisfaction and clinical results 10 years after modified open thoracoplasty for pectus deformities

Correction of pectus excavatum with free latissimus dorsi musculocutaneous flap

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