Funnel Chest Deformity Research Articles

Aesthetic Improvement of the Female Breast in Funnel Chest Deformity by Surgical Repair of the Thoracic Wall

Adults are increasingly seeking surgical correction of pectus excavatum deformity, and the alternative custom-made silicone implant is not always desired or suitable. The paramount concern of female patients is the apparent strabism of their breasts. In some cases, the standard minimally invasive reconstruction of pectus excavatum procedure or a modified approach with a semiopen technique can help remodel the anterior thoracic wall and simultaneously reposition the female breasts to a desired and aesthetically acceptable position. Between November of 2000 and March of 2011, 35 female adolescent and adult patients underwent surgical funnel chest repair with different approaches. In seven of these patients, a pectus bar was implanted using minimally invasive reconstruction of pectus excavatum, whereas 15 underwent a combined semiopen approach. The pectus bar was removed after a period of 14 to 39 months (mean, 31 months) in the minimally invasive reconstruction group and 12 to 25 months (mean, 13.5 months) in the other group. Preoperative and postoperative photographs were examined, and the results were assessed by independent surgeons. During the follow-up period of 1 month to 3.9 years (mean, 12 months), no major complications occurred. The aesthetic appearance of the anterior thoracic wall was distinctly improved, and breast strabism and breast tissue projection were eliminated. Pectus bar implantation appears to be an excellent method for the correction of breast malposition in female adults with a funnel chest deformity. Although invasive, it allows permanent remodeling of the anterior thoracic wall and the décolleté, and a repositioning of the female breast to achieve a natural appearance. Therapeutic, IV.

The Internal Mammary Artery Perforator (IMAP) Breast-Flap Harvested From an Asymmetric Hyperplastic Breast for Correction of a Mild Funnel Chest Deformity

Pectus excavatum deformity is the most frequent congenital anomaly of the thoracic wall. If the invasive surgical procedures of thoracoplasty are not indicated or the patient refuses them, alternative treatment options should be considered. In such cases, local or distant transposition of autologous tissue could be appropriate. This report presents a selected case of funnel chest deformity and concomitant unilateral breast hyperplasia. Both deformities were corrected simultaneously using a pedicled internal mammary artery perforator (IMAP) flap dissected from the hyperplastic breast. This is a safe, reliable, low-morbidity, one-stage option for adult women that uses an easy-to-harvest flap for simultaneous correction of mild funnel chest deformity and concomitant breast hyperplasia with a single resulting scar.

Surgical correction of the funnel chest deformity in children

The aim of this study was to evaluate our results during and after the Nuss operation in children with pectus excavatum. We have performed the Nuss procedure in 128 patients with pectus excavatum since 2001, and 74 patients underwent bar removal. Of the 128 patients 96 were male and 32 were female; age ranged from eight to 21 years with an average of 13.8 years. In 46% of patients psychological reasons for operative treatment were dominant while in the other 54% of patients clinical signs were the indications. Complications in 128 patients included 36 pneumothorax, 28 of which resolved spontaneously. Postoperative pneumonia developed in six patients. In two patients we had infection of the implanted bar, and there were two patients with cellulitis. We had six patients with bar displacement and reoperation was needed. During the Nuss procedure we had one injury of the intercostal artery. We had pericardial tears in two patients without clinical significance. In two patients we had pericardial effusion six months after the Nuss procedure, requiring pericardiocentesis. In one patient we had fracture of the sternum. There were no complications following bar removal. After bar removal in 74 patients, 54 patients (72.9%) maintained excellent results with normal chest anatomy, good results were found in 16 patients (21.6%) with mild residual pectus and poor results in four patients (5.5%) with severe recurrence. Our experience with the Nuss procedure demonstrated excellent results with few minor complications.

Automatic detection and characterization of funnel chest based on spiral CT

Funnel chest (Pectus excavatum) is the most common deformity of the anterior chest in children. Present paper describes a method to process and classify CT slices representing funnel chest deformities. A manually chosen CT slice was processed to detect the inner curvature of the chest for characterization. Normalized data from the detected inner curvature was gained and saved next to a manually-given deformity type for further classification rule determinations. Based on the multiple correlations of the values gained from the inner curvature, a hierarchical classification was performed on 199 patient data. Results have shown that the calculated values gained from the inner curvature can accurately characterize the deformity type of the chest. Since minimal user interaction was necessary to detect and characterize the inner curvature, our method is considered to be an effective automated procedure for funnel chest deformity classifications.

Long-term results of the surgical treatment of the funnel chest deformity

В статті подані віддалені результати хірургічного лікування вродженої лійкоподібної деформації грудної клітки у 27 хворих, яким було встановлено черезгруднинний фіксатор. В результаті дослідження виявлено, що новий фіксатор дозволяє здійснити значну корекцію деформації без травматизації плеври та органів грудної порожнини, а також запобігти виникненню нестабільності імплантата внаслідок його прорізання через кісткову тканину.

Aesthetic and functional correction of female, asymmetric funnel chest – A combined approach

There is still sparse information published about the surgical correction of female funnel chest deformity. Women with severe asymmetric funnel chest deformity often present with asymmetric, hypoplastic breasts. These patients frequently complain of physiological limitations in connection with gross aesthetic impairment. To correct these two features a combined approach is presented in this study. 10 women were operated with correction of the thoracic wall deformity by open retrosternal mobilisation and metal plate fixation. Either during the same procedure or in a secondary operation, submuscular breast augmentation was performed to correct breast hypoplasia and asymmetry. All patients tolerated the operation very well without any complications. Aesthetic outcome was rated good to excellent in secondary breast augmentation, whereas simultaneous implant positioning was prone to cause symmastia. In conclusion we recommend correction of female asymmetric funnel chest by primary sternal reduction with secondary breast augmentation during metal plate removal 1 year after.

Late results of the surgical correction of funnel chest. Evaluation with subjective and objective criteria including moiré topography

The long term results of 32 patients with funnel chest deformity that were operatively treated by means of Rehbein's metal implants have been reviewed. The investigated criteria were electrocardiography, pulmonary function, radiographical measurements, and photogrammetry of the frontal thoracic plane (Moiré-Topography). There was no significant change of the electrocardiography and pulmonary function due to the operative treatment. Roentgenometric and surface measurement data showed in 40% of the cases investigated minor up to complete relapses. According to the results the indications for operative treatment and the importance of the patient's age at this time are discussed.

Late results following surgery for funnel chest

36 out of 62 patients, who underwent surgical correction for funnel chest deformity between 1978 and 1988 with an average follow-up of 7.6 years have been reviewed. The mean age, Hegemann operation was performed, was 14.1 years. 76% of patients reported preoperatively cardiorespiratory disorders, 71% showed electrocardiographic and pulmonary alterations. Postoperatively significant reduction of cardiorespiratory disorders but no significant reduction of electrocardiographic changes were seen. The pre- and postoperative radiological and functional measurements of the chest deformity which provides an objective evaluation of the surgical result are described. Surgical treatment is indicated in most of cases for cosmetic or psychic reasons. The long-term results were good or fair in 90% or more of our cases. We suggested that disfiguring scars with keloid formation causes less mental stress than persistent congenital malformation of the chest.

Minimally Invasive Repair for Treating Pectus Excavatum — Early Results

Minimally invasive repair of pectus excavatum (MIRPE) is the preferred technique for repair of funnel chest deformity. The aim of this study is to evaluate our initial postoperative results, to identify factors related to postoperative complications and to examine the acceptability of MIRPE by the patients. 25 MIRPE patients (20 male and 5 female) were operated on between November 2002 and February 2007 at the Department of Pediatric Surgery, Turku University Central Hospital. The median age of the patients was 14 years (range from 5 to 23 years). One patient had undergone previously open Sulamaa reconstruction and one had a history of intrathoracic lymphoma. The remaining 23 patients had primary pectus excavatum. A right thoracoscopy was performed to every patient. Operative mortality was zero and there were no clinically significant bleeding complications. Epidural analgesia was necessary for adequate pain control. Small symptomless residual pneumothoraxes and pleural effusions were common after the operation but neither required intervention. One patient had a hemothorax 7 months postoperatively, which was cured with a single puncture. Bar displacement took place in 2 patients but required correction in only one of these patients. There were 2 wound infections, one superficial and one which led to removal of the bar was 6 months after the operation. This may have been unnecessary. Two patients had pneumonia, one probably unrelated to the operation. One patient required psychiatric ward treatment, and 3 patients had mild psychological symptoms not requiring specific therapy. The preliminary cosmetic results were good or excellent in 90% of the cases, but a longer follow-up is needed for information on the final outcome. MIRPE is a safe operation and gives a cosmetically good result. Thoracoscopy is needed during the operation. The early postoperative period in hospital is painful and there the patients need intensive care. We found the high epidural analgesia beneficial and safe during early period of pain treatment. The bar is removed not earlier than 3 years after the operation as a day care surgical procedure.

Le thorax en entonnoir : quelle prise en charge en chirurgie plastique ? À propos de 10 cas

Subject Several controversial issues concern pectus excavatum (funnel chest), the most common chest wall deformity. The pathogenesis of this deformity is uncertain, and there is no agreement as to its psychological, cardiac and pulmonary effects. An even more debatable point is the choice of surgical treatment among the more or less radical proposals made by different teams. No consensus exists concerning the indications for surgery, the technique to be used, or the suitable age of the patient. Materials and methods This retrospective study concerns 10 patients with funnel chest who underwent reconstruction surgery in our unit between 1989 and 2002. Nine patients received a silicone chest implant made to measure, and one a single breast implant. Each patient was interviewed and examined to obtain information and provide a basis for evaluation. The effects of possible associated abnormalities were evidenced by complementary cardiopulmonary examinations, and the severity of funnel chest was evaluated according to the Haller pectus index. Results The mean period after surgery was 5 years. The effects of funnel chest deformity were essentially psychological, relating to aesthetic disgrace. Although two-thirds of the deformities were considered severe, cardiopulmonary repercussions were minor. All 10 patients were satisfied with the repair performed, and this judgment was independent of surgical assessment. Acute complications concerned 5 seromas and one minimal scar separation. Discussion The indications for surgery and the means of surgical treatment for funnel chest are considered after comparison of our results with those in the literature and a survey of the different existing possibilities for treatment (implant, chondrosternoplasty, fat transplant).

Surgical aspects of thoracoscopy and efficacy of right thoracoscopy in minimally invasive repair of pectus excavatum

Minimally invasive repair of pectus excavatum has been established as the preferred technique for the repair of funnel chest deformity. Original techniques of pectus bar placement have been modified to improve the safety of the procedures. The aim of this study is to evaluate the efficacy of right thoracoscopy and to identify factors responsible for complications related to thoracoscopy in minimally invasive repair of pectus excavatum, along with a review of the literature. A retrospective analysis was performed on patients who have had a thoracoscopically assisted minimally invasive repair of pectus excavatum at the Department of Pediatric Surgery, Medical University of Graz, Austria, between 2000 and 2006. The port was inserted through the right lateral chest wall in all patients to obtain visual access for bar insertion. Charts of 160 patients (130 male and 30 female) with an age range from 5 to 38 years were evaluated. Surgical time ranged from 25 to 255 minutes (mean 66 minutes). Complications primarily related to thoracoscopy were found in 16 patients (10%). There was 1 case of the port trocar piercing through the liver. Incomplete gas evacuation caused postoperative pneumothorax in 15 patients, 5 requiring thoracocentesis and 2 chest tubes. Insertion of the port in the right lateral chest wall is safe and provides optimum visual access during the minimally invasive repair procedure. Careful interpretation of chest films can assist in judicious determination of the port site. Optimum pressures and near complete evacuation of the insufflation gases can drastically reduce complications. Alternative access sites such as port insertion above the level of bar placement or left-sided and/or bilateral thoracoscopy may not be necessary.

Long-term results after operation for funnel chest.

The cases of 36 out of 62 patients who underwent surgical correction of funnel chest deformity between 1978 and 1988 with an average follow-up of 7.6 years were reviewed. The mean age at which the Hegemann operation was performed was 14.1 years. Preoperative cardiorespiratory disorders were reported by 76% of patients, while 71% showed electrocardiographic and pulmonary alterations. Post-operatively, cardiorespiratory disorders were significantly reduced, but the electrocardiographic changes were not. The pre- and postoperative radiological and functional measurements of the chest deformity which allow an objective evaluation of the surgical result are described. Surgical treatment is indicated in most cases of funnel chest deformity, for cosmetic or psychological reasons. The long-term results were good or fair in 90% or more of our cases. We suggested that disfiguring scars with keloid formation cause less psychological distress than persistent congenital malformation of the chest.

Functional state of the cardiorespiratory system in patients with funnel chest deformity

Functional disorders of the cardiovascular and respiratory systems with pectus excavatum (CFD) have attracted close attention of specialists for a long time. Modern examination methods based on the use of new diagnostic equipment allow obtaining more and more objective criteria for assessing these disorders. However, there are still no clear relationships between the degree of deformity and the severity of cardiorespiratory disorders. Therefore, indications for thoracoplasty are made for cosmetic or other subjective reasons, which is unacceptable in relation to such a complex surgical intervention.

Gradual correction of severe forms of funnel chest deformity

Funnel chest deformity (CFD) is a severe malformation, which, in addition to a cosmetic defect in the form of a depression of the sternum and ribs, is accompanied by various functional disorders in the cardiorespiratory system. The frequency of this defect, according to a number of domestic and foreign authors, varies depending on the region from 0.2% to 1.3%.

Twenty years of experience with particulate silicone in plastic surgery

The use of particulate silicone in plastic surgery involves the introduction of solid silicone into the body. The silicone is in small pieces in order for it to adapt to the shape of the defect. This way large quantities can be introduced through small incisions. It is also possible to distribute the silicone particles from outside the skin to make the corrections more regular. This method has been very useful for correcting post-traumatic depressions in the face and all areas where the depression has a rigid back support. We consider it the treatment of choice for correcting the funnel chest deformity.

A new surgical method for repair of funnel chest.

We have devised a new surgical procedure for the repair of funnel chest deformity, which we have used in 148 of our 154 patients. The procedure involves resection of the deformed thoracic wall, including ribs and sternum, rib-sternal turnover, and anastomosis of the internal thoracic artery and veins. Several preoperative and postoperative examinations, such as bone biopsy, sternal puncture and indium chloride test, revealed definite signs of living tissue. This procedure results in minimal secondary deformity postoperatively and is indicated for adults as well as children.

Mamma-augmentation-plasty after operation for funnel-chest deformity

A technique for correction of funnel chest, a condition found in 91% of chest deformities, has been successfully used in 1141 patients. Among these were 38 females, 4 of whom had mamma-augmentation-plasty performed at the time of removal of the metal strut used in repair of the funnel chest. Great care is needed in selecting patients for the repair of funnel chest and in avoiding postoperative complications.

Pectus excavatum: Resolution after surgical removal of upper airway obstruction

A six-year-old child with obstruction of the upper airway and a pectus excavatum defect ("funnel chest") is presented. Correction of the funnel-chest deformity was observed four years after the performance of a tonsillectomy and adenoidectomy to relieve the obstruction of the upper airway. The relationship between chronic upper-airway obstruction and a pectus excavatum deformity is discussed, and the reversibility of such a deformity is documented.

A family with funnel chest in three generations

A pedigree for funnel chest deformity is reported. In this family, 4 individuals through 3 generations are affected, showing autosomal dominant inheritance.

Surgical correction of pectus excavatum

It has been observed that some patients who had correction of funnel chest deformity by methods which failed to provide fixed elevation of the involved sternal segment developed progressive sagging in later years in spite of looking good at the operating table. This has led to the adoption of a new technique of double sternal support. This procedure has resulted in 35 of 37 children (94%) being classified as excellent or satisfactory. This double support was initially established in 1959 by overlapping the upper transsected sternum while maintaining elevation of the lower end with a soft tissue sling of perichondrium and intercostal muscle. Beginning in 1961, a rigid bridge of rib or stainless steel bar was substituted at the lower end of the sternum. This has provided better support and the current preference of using the steel bar has been validated in this group of patients. The few disappointments were related to removal of the bar earlier than desired, failure to excise all the protruding sternal cartilage stumps or rib graft tips and inability to cover the lateral sternal edges with pectoral muscles. If possible, the steel bar should not be removed before 12 mo. When these pitfalls were avoided, the results were almost uniformly excellent. The wisdom of excising all depressed cartilaginous segments, as advocated by Ravitch in 1949, 4 has been substantiated. A submammary transverse incision has provided an excellent cosmetic appearance. The morbidity has been low and the mortality zero. In spite of the absence of objective evidence of cardiopulmonary dysfunction, there seems to be an almost uniform improvement in appearance and in patient activity following successful correction of the funnel chest. The latter may be as much a psychological response as a physiologic one. The low morbidity, satisfactory long term results, and general improvement in the patient's body image and outlook on life indicate the need to offer correction of the severe pectus excavatum deformity to low risk children.