Treatment Of Pectus Excavatum Research Articles

Implementation and acceptance rates of a specially designed vacuometer for the vacuum bell treatment of pectus excavatum.

Background / PurposeTo report the implementation of a specially designed vacuometer for the ambulatory measurement of the exact negative pressure self-applied by the patient when using the vacuum bell for the treatment of pectus excavatum and to analyze patient satisfaction with the device, by conducting a survey. MethodsBetween October 2018 and June 2020, all patients with pectus excavatum who received a vacuum bell at our Pectus Clinic were provided with a specially designed pectus vacuometer for their personal use. We described the vacuometer, the fundamentals of its development, and the utilization protocol. A survey was conducted evaluating comfort, clarity of instructions, usefulness, simplicity of connection, and likeability. The level of satisfaction was assessed using a Likert scale ranging from 1 (very negative experience) to 5 (very positive experience). The occurrence of skin lesions provoked by the application of the vacuum bell was registered. ResultsFrom 72 submitted surveys, 54 patients answered. Patient demographics comprised 44 (81.5%) males and a mean age of 12.6 ± 6.0 years. The mean initial external pectus depth was 2.0 ± 0.7 cm and the mean duration of treatment was 13.2 ± 8.6 months. No skin lesions were detected while using the vacuum bell and the vacuometer. The mean general satisfaction score was 4.4 ± 0.7 and 83.3% of the respondents did not have any inconvenience with the vacuometer. A patient who considered himself cured was the only dropout during the study. ConclusionsIn this study, we described the feasibility and fundamentals of the application of a specifically designed vacuometer for ambulatory use as an adjunct to the treatment of pectus excavatum with a vacuum bell, and demonstrated a high satisfaction level with the device. In addition, the vacuometer might help avoid skin lesions secondary to the vacuum bell and foster adhesion to treatment. Type of studyTreatment study. Level of evidenceIV

Surgical correction of pectus excavatum in an adult with the use of thoracoscopic intercostal nerve cryoablation

Despite the improvement of the surgical approach for the correction of pectus pectus deformity, the reduction of the invasiveness of the intervention and the use of modern technologies, the optimal technology for the prevention and treatment of postoperative pain has not yet been determined. We have presented an alternative approach to regional analgesia for surgical treatment of pectus excavatum.

Challenging beliefs:A review of the paradigm shift in the treatment of pectus excavatum from radical resection to minimally invasive bracing and non-surgical vacuum bell suction.

In 1997, Nuss introduced a minimally invasive non-destructive procedure for pectus excavatum, which revolutionised the treatment of the condition. This review will give a brief history on the management of this condition, followed by a review of 1 034 cases that have been repaired from 2008 to 2018.

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

The Nuss procedure is the gold standard surgical treatment for pectus excavatum in young patients. Its use in adults has also been described, although it may be associated with increased postoperative morbidity resulting from higher chest wall rigidity. This study aimed to examine the risk of complications after the Nuss procedure in adult patients compared with young patients with pectus excavatum. This single-center retrospective cohort study evaluated all patients who underwent the Nuss procedure between 2006 and 2018. Patients were stratified by age as young (≤24 years old) and adult (>24 years old). The primary end point was the occurrence of perioperative or postoperative complications, subdivided into major (Clavien-Dindo class IIIa or higher) and minor (less severe than Clavien-Dindo class III). Between-group differences were analyzed using the Mann-Whitney U and the χ2 test with post hoc analysis. A total of 327 participants were included, 272 in the young group (median age, 16 years; interquartile range [IQR], 15 to 18 years; range, 11 to 24 years) and 55 in the adult group (median age, 32 years; IQR, 27 to 38 years; range, 25 to 47 years). The median Haller index was similar between groups (young, 3.7; IQR, 3.2 to 4.4 vs adult,3.6; IQR, 3.0 to 4.3; P= .44). The median follow-up was 34 and 36 months, respectively. The incidence of major complications was comparable between young and adult participants (P= .43). Minor complications occurred more often among adults (young, 4% vs adult, 11%; P= .002). Chronic postoperative pain was the only minor complication with a significant difference in incidence (young, 1% vs adult, 7%; P= .008). The Nuss procedure is a safe surgical treatment for pectus excavatum in both young and adult patients. The risk of major complications is comparable. However, adults more often have chronic pain.

The vacuum treatment for the pectus excavatum thickened subcutaneous fat of the chest wall and is effective in preteenagers.

We report effects of treatment for pectus excavatum (PE) with a Vacuum Bell (VB). Fifteen patients (13 males and 2 females) undergoing VB therapy over 6years, aged 6-17years (mean: 11.1years), were divided into two Groups: Group 1 (G1), preteenagers (< 13years); Group 2 (G2), teenagers (≧ 13years). We retrospectively recorded changes in depth of depression and the Haller index. The depth of depression reduced in 93.3% of 15 patients (mean; 8.7mm). Minimal change occurred in the Haller index but the subcutaneous fat thickened significantly (11/15 patients). The improvement rate on elevation of the chest wall was better in G1 than G2 (G1: 54.0% vs G2: 51.3%). The maximum depth of depression improved in PE patients as a result of thickening of subcutaneous fat. VB is most effective in preteenagers with PE.

A novel three-dimensional printed vacuum bell for pectus excavatum treatment: a preliminary study

ObjectiveConservative treatment with a vacuum bell (VB) for pectus excavatum (PE) has now been gradually popularized as an alternative to surgery. We describe our initial experience with a novel three dimensional (3D) printed VB device.MethodsProspectively collected data of all patients who started using a 3D printed VB in 2018 at our institution were analyzed. Linear and logistic regressions were used to identify factors associated with effectiveness of device usage.ResultsIn total, forty-two patients with a median age of 3.6 years were treated with the device. The median follow-up duration was 11.1 months and the mean initial Depth Ratio (DR) was 0.129. There were no permanent sequelae from side effects. Thirty patients with at least one follow-up body scan data showed varying improvement (z = − 4.569, p = 0.0000). Linear regression suggested that longer usage improved outcomes (R2 = 0.235, p = 0.014). By logistic regression there was a trend of younger ages and less initial DR for better improvement though neither was statistically significant (p = 0.086, 0.078, respectively).ConclusionOur initial experience has shown the 3D printed VB may be as effective as other conventional VBs and could be used as an alternative to surgical treatment for selected patients with PE. More experience and studies with this type of VB are needed to demonstrate its superiority with regard to the 3D printing design and optimal timing and indication for use.

Noninvasive treatment of pectus excavatum with a vacuum bell combined with a three-dimensional scanner

Our aim was to evaluate the effect of a vacuum bell (VB) combined with a three-dimensional (3D) scanner for the noninvasive treatment of pectus excavatum (PE). A VB was used to create a vacuum at the anterior chest wall with a patient-activated hand pump, and it should be applied regularly for more than 2h each day at home. Eighty-two patients required to be followed up every three months were included in this retrospective study and distributed into four stages (stage 1: treated for 3months, stage 2: treated for 6months, stage 3: treated for 9months, and stage 4: treated for 12months). In addition, the deformity in the chest wall was scanned by a 3D scanner at the clinic, and the 3D depth (3D-DE) and 3D Haller index (3D-HI) of PE were calculated through Geomagic studio 2013 software. Eighty-two patients (12/2017-12/2019) met the criteria at the clinic, and 24 patients (29.3%) achieved excellent correction (3D-DE ≤ 3mm). When comparing the improvement in 3D-DE and 3D-HI of PE to the patient's treatment time, a statistically significant difference was observed between stages 2 and 1 (3D-DE p<0.01, 3D-HI p<0.01), stages 3 and 2 (3D-DE p<0.01, 3D-HI p<0.01) and stages 4 and 3 (3D-DE p<0.01, 3D-HI p<0.01). There was a statistically significant difference in sternum elevation between patients aged <10years and those aged ≥ 10years (3D-DE p = 0.006, 3D-HI p = 0.045) and patients with symmetrical and asymmetric PE (3D-DE p = 0.042, 3D-HI p = 0.032). However, there was no statistically significant difference in sternal elevation between males and females (3D-DE p = 0.27, 3D-HI p = 0.495). The main side effects were moderate subcutaneous hematoma, petechial bleeding, thoracalgia and chest tightness. With controllable side effects, noninvasive treatment for PE with a VB combined with a 3D scanner is safe, objective and radiation free, and the initial results to date are encouraging. Patients aged <10years, with symmetrical PE and treated for over 12months may achieve a better outcome.

Interventions with Music in PECTus excavatum treatment (IMPECT trial): a study protocol for a randomised controlled trial investigating the clinical effects of perioperative music interventions

IntroductionPectus excavatum repair is associated with substantial postoperative pain, despite the use of epidural analgesia and other analgesic regimens. Perioperative recorded music interventions have been shown to alleviate pain and...

Trends in the Treatment of Pectus Excavatum in the Netherlands.

Pectus excavatum (PE) is the most common deformity of the anterior chest wall and can be corrected surgically with different techniques. In the past years, medical literature suggests that the minimal invasive surgical correction of PE (MIRPE) has currently become the operation technique of choice in Europe, and the number of PE patients undergoing surgery has increased. The aim of this study was to evaluate trends in the number of patients operated on and the surgical techniques generally used in patients with PE in the Netherlands. From the registration by Statistics Netherlands, the numbers of live births and gender were obtained for the period 1980 to 2017. Furthermore, from the Dutch hospital registration performed by Kiwa Prismant systems, the number of total surgical procedures of PE patients from the period 1998 to 2017, and the numbers of open and MIRPE surgery were obtained over the period 2005 to 2013. The birth rate in Netherlands has stayed more or less stable in the last two decades. The number of PE patients asking for correction, however, has increased. In addition, the percentage of thoracoscopic assisted correction has increased. The increase in correction of PE is not due to an increased incidence but to an increase of patient wishes. The use of MIRPE is gaining popularity over time.

Update on Body Shaping and Volume Restoration: The Role of Hyaluronic Acid.

After the introduction of facial aesthetic injectables with botulinum toxin (BoNt) in the first half of the 1990s and nonanimal-based hyaluronic acid (HA) fillers in 1996, the interest for minimally invasive procedures has exploded. With this background, it is not surprising that the interest for body contouring with HA has also attracted a lot of interest. The effectiveness and safety for breast augmentation, buttock augmentation and treatment for pectus excavatum has been extensively investigated and published. Generally, patient satisfaction has been high and complications low. Due to several factors such as limited duration and unfavorable cost, HA fillers have been withdrawn from the market. With the development of new HA products, it is possible that its use for body contouring will be reintroduced and popular in the future.

Numerical investigation of the sternoclavicular joint modeling technique for improving the surgical treatment of pectus excavatum

It is now common to perform the Nuss procedure as a surgical treatment for pectus excavatum. As several types of detailed surgical methods exist as part of the Nuss procedure, studies are currently being conducted to verify their relative superiority via computerized biomechanical methods. However, no studies have considered the influence of sternoclavicular joints on the simulations of the Nuss procedure. Accordingly, this study aims to demonstrate the influence of these joints by comparing the clinical data with the finite element analysis data. Scenarios were set by classifying the movement of the joints based on the constraints of translation and rotation in the coordinate plane. The analyses were performed by applying the set scenarios to the constructed finite element model of a chest wall. The sternal displacement, Haller index, and equivalent stress were obtained from the analysis, and the data were compared with the data of the postoperative patient. When the translation of the anterior direction on the chest wall was constrained, the result obtained thereof was found to be similar to those obtained in the actual surgery. It is suggested that more accurate results can be obtained if the influence of the sternoclavicular joints is considered.

Video thoracoscopic treatment of pectus excavatum with the minimally invasive technique nuss

Introduction: The pectus excavatum is a mmon malformation of the anterior wall of the thorax, characterized by a depression of the sternum and impaired sternal condro joints. In most cases, congenital in origin and evolution. Reaches its greatest deformity in adolescence. For many surgical treatment techniques involving extensive resections of costal cartilages and mobilization of the sternum were used. In 1998 Donald Nuss describes a technique where video thoracoscopic introduces a sternal retro metal bar, which is inserted through a small incision on each side of the chest wall, malformation running without resection of costal cartilages or section and / or and/or sternal mobilization. Goals: To report our experience in two surgical centers, for pectus excavatum the treatment with the technique of video thoracoscopic Nuss. Work retrospective, descriptive. Materials and methods: Work retrospective, descriptive. From December 2015 to December 2019 surgically treat pectus excavatum 72 patients using the technique video thoracoscopic Nuss. Results: 63 males and 9 females. The age range at the time of surgery was 7 to 18 years (mean 15.7). Six patients older than 18 years were excluded from the sample. The average rate for Haller in this population was 4.1. All patients got a metal bar sternal retro video thoracoscopic under control, side stabilizers were placed in all patients (65 bilateral and 7 unilateral). Epidural catheter was placed for postoperative analgesic analgesia management in 100% of cases. The average operating time was 94 min. (70-110 min). Intra-operative difficulties: one bar too high had to reposition itself in the same surgical procedure, the mean average hospitalization was 9.7 days (5 -27 days). Post operative complications: The most common early complication was pneumothorax self-limiting in patients 11 (15.2%). The most severe complication was purulent pneumonia with effusion and pleural drainage needed toilette video thoracoscopy 1 (1.3%). Three patients (4.1%) had granulomas wound. Late migration of the bar that was surgically corrected with good outcome. In 65 (90%) patients, the results were very good and good; 5 (6.9%) regular and 2 (2.7%) bad due to the presence of asymmetry chest. Conclusions: Thoracoscopic technique video Nuss is safe, effective and reproducible for the treatment of patients with pectus excavatum. Parietal approach a minimum and low morbidity. The aesthetic results are very satisfactory.

Rib deformity correction in children with pectus excavatum

The article is devoted to a comparative analysis of the surgical treatment of pectus excavatum. A prospective, single-center, non-randomized study of the immediate results of the correction of pectus excavatum in children and adolescents is presented.&#x0D; Material and methods. The treatment results of 40 patients (27 men and 13 women) aged 3 to 18 years, operated between March 2005 and March 2016 were analyzed. All patients were examined according to the standard algorithm: chest MSCT, spirometry. All patients were divided into 2 groups. Group I patients operated on by the open resection method with plastic surgery of the costal arches (n=27). Group II patients operated with the use of minimally invasive technology according to NUSS, which does not provide for correction of deformation of costal arches (n=13).&#x0D; Results. In group II, significantly less blood loss was noted (35.7 ml versus 137 ml in group I, p0.05), shorter duration of surgery (230 min versus 27.5 min in group I, p0.05). It is worth noting the earlier discharge from the hospital in patients with minimally invasive correction of deformity.&#x0D; Conclusion. Minimally invasive thoracoplasty is an effective way to correct pectus excavatum in children and adolescents, which can significantly reduce the duration of surgery and intraoperative blood loss, is comparable in basic terms with reconstructive surgery, but inferior due to the lack of correction of deformation of the rib arches.

TINAG mutation as a genetic cause of pectus excavatum

To investigate the possible involvement of germline mutations in pectus excavatum (PE). We investigated a four-generation pedigree with PE. Whole-exome sequencing (WES)was performed to identify potential mutations for PE formation. Sanger sequencing was used to validate these mutations. hFOB1.19 cell proliferation was measured with a Celigo imaging cytometry system. There were four PE patients in this four-generation pedigree. In the four patients, we identified a novel heterozygous stop-gain variant in Tubulointerstitial Nephritis Antigen (TINAG) through exome sequencing: c.G2A, p.W2*. This mutation was validated by Sanger sequencing. Knockdown of TINAG inhibited the proliferation of hFOB1.19 cells. Based on these results, we hypothesize that the TINAG c.G2A mutation is a loss-of-functionmutationthat reduces TINAG expression. Increasing TINAG warrants further investigation as a potential novel anabolic mechanism of PE treatment.

Metal allergy after the Nuss procedure for pectus excavatum: a review.

Minimally invasive repair of pectus excavatum (MIRPE) technique (the Nuss procedure) is a minimally-invasive method that is commonly used in the treatment of pectus excavatum. An allergic reaction to the metal alloy bar that is implanted in the thorax during the procedure is a reported complication. We briefly review current literature concerning epidemiology, mechanisms and research results of allergic reactions after Nuss bar implantation. This allergic reaction occurs in approximately 2.7% of patients and is caused by metals used in the medical implant. The most common symptoms include fever and skin lesions such as allergic dermatitis. Elevated levels of C-reactive protein is a frequent finding in laboratory tests. In order to minimize the risk of such complications, taking a detailed allergy-based medical history and conducting allergy tests, i.e. patch test are required. Allergic reactions can be managed with conservative treatment such as general or topical glucocorticosteroid therapy and antihistamine agents. Severe allergic reactions can be addressed by implant revision, replacement of the steel bar with a titanium substitute or removal of the stabilization at all. Although the risk of an allergic reaction to titanium is smaller it still exists, the titanium substitute is not routinely used due to its higher cost and lesser plasticity which has a negative impact on matching a stabilizing bar during the surgery. Surgeons treating pectus excavatum should remember about the possible allergic reactions after implantation of the metal bar and be familiar with methods of diagnosis and treatment of those complications.

Simultaneous surgical treatment for pectus excavatum combined with congenital cardiothoracic diseases

To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases. Methods: The medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children's Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic disease group (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently. Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed. Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.

Pectoralis Muscle Transposition in Association with the Ravitch Procedure in the Management of Severe Pectus Excavatum.

Background:Pectus excavatum (PE) is the most common congenital chest wall deformity. PE is sometimes associated with cardiorespiratory impairment, but is often associated with psychological distress, especially for patients in their teenage years. Surgical repair of pectus deformities has been shown to improve both physical limitations and psychosocial well-being in children. The most common surgical approaches for PE treatment are the modified Ravitch technique and the minimally invasive Nuss technique. A technical modification of the Ravitch procedure, which includes bilateral mobilization and midline transposition of the pectoralis muscle flap, is presented here.Methods:From 2010 to 2016, 12 patients were treated by a modified Ravitch procedure with bilateral mobilization and midline transposition of the pectoralis muscle flap for severe PE. Outcomes, morphological results, and complications were analyzed with respect to this new combined surgical approach.Results:There was a statistically significant difference between pre- and postoperative values (P = 0.0025) of the Haller index at the 18-month follow-up, showing a significant morphological improvement for all treated patients. After surgery, no morbidity and mortality were noted. The mean hospital stay was 7 days, and all patients were discharged without major complications.Conclusion:This technique significantly improved patients’ postoperative morphological outcomes and significantly reduced long-term complications, such as wound dehiscence, skin thinning, and hardware exposure.

The consistency of an optical body surface scanning method compared with computed tomography: a validation study

ObjectiveThe ideal noninvasive method for evaluation of pectus excavatum remains to be defined. We sought to verify the accuracy of an optical body surface scanning method compared with conventional CT scan. Materials and methodsA PrimeSense 3D sensor was used to obtain data from patients undergoing surgical or noninvasive treatment for pectus excavatum. The Haller index, external Haller index, and depth ratio were then calculated from both body scan and computed tomography scan data for the same patients. Statistical analyses were carried out to find if there is consistency between data from body scanning and computed tomography. ResultsData acquisition was complete. In total, 40 patients (median age: 5.03 years, 11 female) with pectus excavatum undergoing nonoperative (n = 13) or surgical Nuss treatment (n = 27) were included. The Haller index was lower in vacuum bell patients, which also had a higher female proportion. Pearson correlation coefficient between external Haller indices from body scanning and from computed tomography and between the depth ratios from body scanning and from computed tomography were 0.63 and 0.84, respectively. By intraclass correlation coefficient method, the correlation coefficient was 0.56 between external Haller indices from body scanning and from computed tomography and 0.80 between depth ratios from body scanning and from computed tomography. ConclusionThe optical body surface scanning is a reliable approach to the measurement of PE severity and could be routinely used in the monitoring of PE development of treatment, especially in the pediatric population. Study typeDiagnostic test. Level of evidenceLevel II.

Experience with Wang procedure for treatment of pectus excavatum in young children

To review the experience with Wang procedure for treatment of pectus excavatum in young children. The clinical data of 21 children with a mean age of 3.3 ± 1.1 years (ranging from 1.5-6 years) undergoing Wang procedure for pectus excavatum were analyzed. A longitudinal incision (1 to 2 cm) was made in the front of the xiphoid, and two tunnels were created using steel bars beneath the muscles on two sides of the chest wall. The fibrous tissue between the diaphragm and the sternum was dissociated, and the steel wires were sutured through the deformed chest wall. After the steel bar was placed in the tunnels, the wires were pulled and fixed in the middle of the bar, and the incision was sutured. All the operations were performed using 3 wires and 1 steel bar. The operation time was 25 to 51 (38.1 ± 9.6) min with an intraoperative bleeding volume of 5 to 10 (7.1±1.5) mL. The time of hospitalization of the patients ranged from 6 to 10 days (mean 8.1±1.3 days). In all the patients, the incision healed smoothly without serious pain or obvious complications. All the patients were followed up for 1 to 13 months after the operation. During the follow- up, no recess recurred and no such complications as bar displacement or transposition occurred. According to the evaluation criteria after pectus excavatum operation, 13 cases had a total score of 9, and 8 had a total score of 8. The overall effect was satisfactory, and there were no cases rated as basically satisfactory or unsatisfactory. Wang procedure is a good option for treatment of pectus excavatum in young children.

An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment.

BackgroundPectus excavatum (PE) is sometimes associated with psychological and physiological difficulties influencing a patient’s quality of life. Treatment with a hyaluronic acid (HA)-based gel may benefit patients and be an alternative to other more invasive treatments.ObjectivesThe authors sought to evaluate the effectiveness in terms of satisfaction, duration, and safety of HA gel treatment for PE including impact on quality of life.MethodsMales ≥18 years having PE without functional problems received HA gel injections (50 – 150 mL) at the site of deformity and in some cases at the medial pectoralis muscle borders to optimize the aesthetic result. Follow-up visits were performed after 1, 3, 6, 12, and 24 months with optional retreatment at the 24-month visit including a 1-month follow-up. Evaluations included Pectus Excavatum Evaluation Questionnaire, patient satisfaction, magnetic resonance imaging, and safety assessments.ResultsThe treatment significantly improved patients’ self-esteem (P < 0.001) and psychosocial function (P ≤ 0.038) throughout the study, as assessed by Pectus Excavatum Evaluation Questionnaire. Patients were satisfied with the aesthetic outcome and considered the treatment mild in terms of level of pain during injection. Treatment effects were maintained up to 24 months and 58% of the HA gel remained at this visit, shown by Magnetic Resonance Imaging measurements. The treatment was well tolerated.ConclusionsTreatment of PE with HA gel improved patient quality of life related to self-esteem and psychosocial functioning including aesthetically pleasing results. The treatment may also offer benefits in terms of safety and tolerability compared with other treatments.Level of Evidence: 4