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The Journal of Cardiovascular Surgery 1999 October;40(5):725-31

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Surgical correction of pectus excavatum and carinatum

Robicsek F., Fokin A.

From the Department of Thoracic and Cardiovascular Surgery Carolinas Medical Center and The Heineman Medical Research Foundation Charlotte, North Carolina, USA


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The ­author ­presents ­three ­decades of expe­ri­ence in the man­age­ment of ante­rior ­chest ­wall defor­mities. ­During ­this ­period ­more ­than 800 oper­a­tions ­were per­formed on ­patients ­with ­pectus exca­vatum and car­i­natum. In ­this ­series, ­there was no ­death and ­serious com­pli­ca­tions ­were ­rare. The ­author ­believes ­that the prin­ci­ples on ­which sur­gical treat­ment of ­pectus exca­vatum ­should be ­based are as fol­lows: (1) bilat­eral ­removal of the “cul­prit” ­costal car­til­ages, (2) ade­quate mobil­iza­tion of the ­sternum and cor­rec­tion of the ­sternal posi­tional defor­mity by trans­verse oste­otomy, (3) sta­bi­lizing the cor­rected posi­tion of the ­sternum ­with a sub­sternal “ham­mock” sup­port. ­Using ­this tech­nique the ­author devel­oped new sur­gical tech­niques for the cor­rec­tion of dif­ferent varie­ties of ­chest ­wall defor­mities: ­Pectus exca­vatum, asym­metric ­pectus exca­vatum, ­pectus car­i­natum ­with ­xiphoid angu­la­tion, hor­i­zontal ­pectus exca­vatum, asym­metric ­pectus car­i­natum, chon­dros­ternal prom­i­nence ­with chon­dro­glad­i­olar depres­sion, and recur­rent ­pectus exca­vatum. The ­present ­method ­applied for cor­rec­tion of ­pectus exca­vatum uti­lizes the ­above prin­ci­ples and a sub­sternal ­Marlex ­mesh sup­port ­with bilat­eral ­muscle ­coverage. For car­i­natum ­repair, the ­author rou­tinely ­uses posi­tional cor­rec­tion of the ­sternum and ­sternal short­ening. ­Patients who ­have sig­nif­i­cant ­pectus defor­mities ­should ­undergo sur­gical ­repair, pref­er­ably ­between one and ­eight ­years of age.

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