Operative treatment of congenital deformities of the chest

Abstract

Congenital deformities of the chest may have serious physiologic consequences, quite apart from the undesirable visible orthopedic and cosmetic deformities. The defects of sternal fusion are best corrected as soon after birth as the patient is seen and, in those instances in which there are associated defects, these are corrected simultaneously. A wide range of anomalies involving the ribs and cartilages with or without absence of the overlying musculature lead to striking deformities which are progressive, if not corrected. Osteoplastic repairs have been more satisfactory than prosthetic replacements. Pectus excavatum is the deformity in which there is the greatest surgical experience. Satisfactory correction can be achieved by subperichondrial resection of the involved chondral segments and a corrective osteotomy of the sternum. We do not use external traction and very infrequently employ internal struts. The operation is best undertaken in infancy, whenever a severe or progressive defect is seen. In older children we operate on all with severe deformities in the absence of complicating disease. In adults we operate only on those patients who are symptomatic. Protrusion deformities seem to be symptomatic, largely by virtue of associated concavities of portions of the sternum, costal cartilages and ribs. Operations directed at the correction of the concavities yield gratifying results.