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Pectus excavatum and carinatum. Pectus excavatum and carinatum are the riesfo common morphological chest wall abnormalities. For both pectus excavatum and carinatum the pathogenesis is largely unknown although various hypotheses exist.
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Usually, exclusion of an underlying syndromal or connective tissue disorder is the reason for referral for genetic evaluation. A detailed anamnesis and family history are needed as well as a complete dysmorphological physical examination. Minimally invasive repair of pectus excavatum. Pectus excavatuman acquired or congenital depression of the anterior chest wall, is the most commonly occurring chest wall deformity. Traditionally, repair of the defect was performed with vuvir major open operation, the most common being based on modifications of the Ravitch procedure.
This approach utilizes thoracoscopic visualization with small incisions lodham placement of a temporary metal bar positioned behind the sternum for support it while the costal cartilages remodel.
Since introduction, the minimally invasive repair of pectus excavatum MIRPE has become accepted in many centers as the procedure of choice d repair of pectus excavatum. In experienced hands, the procedure has excellent outcomes, shorter procedural length, and outstanding cosmetic results.
However, proper patient selection and attention to technical details are essential to achieve optimal outcomes and prevent significant complications. In the following, we describe our perspective on pectus excavatum deformities, operative planning, and technical details of the MIRPE procedure. Surgical correction of pectus excavatum and carinatum. This paper contains an analysis of the long-term results in 85 patients who had pectus excavatum or carinatum deformities repaired at the North Middlesex Hospital between and Seventy-seven patients had operations for correction of pectus excavatum and eight for pectus carinatum.
A variety of surgical techniques was used. In the excavatum deformities the best results were obtained by the extensive resection of all deformed cartilages, the correction of the sternal deformity by a simple transverse wedge osteotomy, and by stabilising the chest with a stainless steel plate. For pectus carinatum, the involved cartilages were resected and an osteotomy of the sternum was performed. We preferred in most cases to stabilise the chest wall with a metal strut in this deformity as well.
The best cosmetic results were achieved by the use of a stainless steel plate passed beneath the sternum and left for not more than six months.
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Surgical repair of iames excavatum and carinatum. The author discusses different forms of pectus deformities and presents appropriate surgical methods he developed for their correction. For pectus excavatumthe surgical technique includes conservative sub-perichondral resection of deformed costal cartilages and detachment of the xiphoid process. A transverse sternotomy is performed at the upper level of the deformed sternum, which is then bent forward. The corrected sternal position is secured by a “hammock” of synthetic mesh, spread behind the sternum, and attached to the respective cartilage remnants.
The pectoralis muscles are then united presternally. The initial steps of pectus carinatum correction are similar to that of pectus excavatum.
The sternum, however, is not freed of its environment. A length of cm is resected from the distal sternum and the xiphoid process is reattached in the proper vivif direction. Measures to correct different anatomical varieties, such as pouter pigeon breast, asymmetrical pectus excavatumand carinatum, are discussed individually.
Osteopathic medicine places a special emphasis on the musculoskeletal system, and understanding how chest wall structure may influence function is critical. Pectus excavatum is a common congenital chest wall defect in which the sternum riesog depressed posteriorly. Patients may present with complaints of chest wall discomfort, exercise intolerance, and riesvo.
The medical implications, diagnosis, and treatment options for patients with pectus excavatum are reviewed.
Minimal invasive surgery has become the gold standard for surgical repair of pectus excavatum. The procedure can be performed as fast-track surgery and cosmetic results are excellent. In addition, cardiac performance improves after correction.
With increased awareness on the Internet, the number of patients who seek help continues to rise, primarily for cosmetic reasons. Pectus carinatum is much less frequent than pectus excavatum.
Over the past decade surgery has largely been replaced by compression techniques that use a brace, and cosmetic results are good.
Rare combinations of pectus excavatum and carinatum may be treated by newer surgical methods. Silicone implant correction of pectus excavatum. Between May and December in 24 adult patients with pectus excavatuma subcutaneous implantation of silicone prostheses was performed. Of the 24 patients, 20 were followed. During follow-up the authors encountered seroma complications in 13 patients and postoperative hematoma in 4 patients.
Patient satisfaction was also taken into consideration. A follow-up survey questioned whether patients were satisfied with the cosmetic outcome. Silicone implant correction of pectus excavatum in adult patients without any impairment of cardiopulmonary function has value. The major advantages are the minimally invasive operation, the short hospital stay, good aesthetic results, and high patient satisfaction.
Pectus excavatum and pectus carinatum represent the most frequent chest wall deformations. However, the pathogenesis is still poorly understood and research results remain inconsistent. To focus on the recent state of knowledge, we summarize and critically discuss the pathological concepts based on the history of these entities, beginning with the first description in the sixteenth century.
Based on the early clinical descriptions, we review and discuss the different pathogenetic hypotheses. To open new perspectives for the potential pathomechanisms, the embryonic and foetal development of the ribs and the sternum is highlighted following the understanding that the origin of these deformities is given by the disruption in the maturation of the parasternal region.
In the second, different therapeutical techniques are highlighted and based on the pathogenetic hypotheses and the embryological knowledge potential new biomaterial-based perspectives with interesting insights for tissue engineering-based treatment options are presented.
Reactive pectus carinatum in patients treated for pectus excavatum. The Ravitch and minimally invasive Nuss procedures have brought widespread relief to children with pectus excavatumchest wall deformities, over the last half century.
Generally accepted long-term complications of pectus excavatum repair are typically limited to recurrence of the excavatum deformity or persistent pain. This study examines the authors’ experience with patients who develop a subsequent carinatum deformity within 1 year of pectus excavatum repair. The authors retrospectively assessed the charts of all patients diagnosed as having a carinatum deformity subsequent to treatment for pectus excavatum at a tertiary urban hospital.
We noted age at original correction of pectus excavatumtime from original correction to diagnosis of carinatum deformity, age at correction of carinatum deformity, complaints before correction, methods of repair, postoperative complications, and we reviewed relevant radiography. Three patients who underwent pectus excavatum repair between January and August developed a subsequent carinatum deformity.
Two patients initially underwent minimally invasive Nuss correction of pectus excavatum ; 1 patient underwent the Ravitch procedure. Within 1 year of original correction and despite intraoperative achievement of neutral sternal position, a protruding anterior chest deformity resembling de novo pectus carinatum emerged in each patient; we term this condition reactive pectus carinatum. The mean age of patients undergoing initial pectus excavatum repair was 13 years range, years.
The pathophysiology of this reactive lesion is not well understood but is thought to originate from reactive fibroblastic stimulation as a result of sternal manipulation and bar placement. Patients who underwent Nuss correction initially were managed with early bar removal.
Two of the patients eventually required surgical resection of the carinatum deformity at a time interval of 3 to 6 years after initial excavatum repair.
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Scoliosis after pectus excavatum correction: Scoliosis is associated with pectus excavatum. However, the change in the degree of scoliosis after pectus excavatum correction has not been clarified.
This study examined how the correction of pectus excavatum riessgo the status of pre-existing scoliosis. A total of pectus excavatum patients operated between and using the pectus bar were retrospectively analysed. Preoperative severity and postoperative change of scoliosis in accordance with the severity of pectus excavatum were evaluated.
Cobb angle, Haller index and sternal tilt degree were measured from pre- and oldhak whole-spine anteroposterior radiographs and chest computed tomography. No jqmes correlation was noted between postoperative changes in Vivie angle, Haller index or sternal tilt angle.
Therefore, pectus excavatum with concomitant moderate scoliosis requires extra caution during repair. This preliminary result suggests further investigation into the effect of chest cage remodelling on spine dynamics. Pectus excavatumthe most frequent congenital chest wall deformity, may be rarely observed as a sole deformity or as a sign of an underlying connective tissue disorder. To date, only few studies have described correlations between this deformity and heritable connective tissue disorders such as Marfan, Ehlers-Danlos, Poland, MASS Mitral valve prolapse, not progressive Aortic enlargement, Skeletal and Skin alterations phenotype among others.
When concurring with connective tissue disorder, cardiopulmonary and vascular involvement may be associated to the thoracic defect.
– Bitácora del Scriptorium –
Ruling out the concomitance of pectus excavatum and connective tissue disorders, therefore, may have a direct implication both on surgical outcome and long term prognosis. In this review we focused on biological bases of connective tissue disorders which may be relevant to the pathogenesis of pectus excavatumportraying surgical and clinical implication of their concurrence.
Symptomatic Pectus Excavatum in Seniors: Doctors all over the world consider a pectus excavatum usually as an incidental finding. There is some evidence suggesting that a pectus excavatum may cause symptoms in the elderly. It is not known how often a pectus excavatum occurs and how strong the relation is with symptoms. In hospitals and general practice data, we searched for evidence of a connection between cardiac symptoms and the jamds of a pectus excavatum in a retrospective survey among patients in whom a pectus excavatum was found in a chest X-ray.
The identified X-rays were reviewed by 2 radiologists. Reported symptoms were combined to a severity sum score and the relation with pectus excavatum was assessed through logistic regression. Pectus excavatum was found in 1 to 2 per chest X-rays. We found a significant relation between the SPES sum score and vivid radiological level of re excavatum. A pectus excavatum found when examining the patient should not be neglected and should be considered as a possible explanation for symptoms like dyspnoea, fatigue, or palpitations.
Casting the implant for reconstruction of pectus excavatum. Fourteen patients with pectus excavatum underwent a total of 17 operations for the insertion of subcutaneous implants aimed at camouflaging their defects. A silicone prosthesis in one patient early in the series caused severe capsular formation. Although a block of Proplast may occasionally be used with success, the rational solution to the problem is to produce a custom made Silastic implant that adheres optimally to the defect in each individual case.
This retrospective study shows that a subcutaneous implant clearly improves the appearance of the chest wall in most of the patients.