Comparison of the Nuss and sternal turnover procedures for primary repair of pectus excavatum

Evaluation of In Vivo Wound-Healing and Anti-Inflammatory Activities of Solvent Fractions of Fruits of Argemone mexicana L. (Papaveraceae)

INTRODUCTION

The solvent fractions of the fruits of Argemone mexicana L. (Papaveraceae) have not yet been explored scientifically for in vivo wound healing and anti-inflammatory activities. The objective of this study was, therefore, to evaluate in vivo wound healing and anti-inflammatory activities of the solvent fractions of the fruit of Argemone mexicana L. (Papaveraceae) in rats.

METHOD

The crude extract of Argemone mexicana was fractionated with n-hexane, ethyl acetate, and distilled water. Wound healing activity was evaluated using excision and incision wound models while anti-inflammatory activity was evaluated using carrageenan-induced rat paw and cotton pellet-induced granuloma models. The fractions were evaluated at 5 and 10% ointments using moist-exposed burn ointment as the standard drug, and 100, 200, and 400 mg/kg test doses using aspirin, and dexamethasone as standard drugs for wound healing and anti-inflammatory activities, respectively. All treatment administrations were made orally for anti-inflammatory activity and applied topically for wound healing activity.

RESULT

The 10% w/w ethyl acetate fraction ointment showed a significant percentage of wound contraction, reduced period of epithelialization, increased amount of fibrosis, neovascularization, and collagen tissue formation (p < 0.01). The ethyl acetate fraction also showed a significant increase in tensile strength (55%; p < 0.01) and (81.10%; p < 0.01) at the tested doses of 5 and 10% w/w ointments, which was comparable to moist-exposed burn ointment. The ethyl acetate fraction also revealed a significant percent edema inhibition (61.41%; p < 0.01), suppression of the exudate (38.09% p < 0.01), and granuloma mass formations (53.47% p < 0.01) at the tested dose of 400 mg/kg.

CONCLUSION

The results of this study showed that the Ethyl acetate fraction of Argemone mexicana fruit has significant wound healing and anti-inflammatory activities which support the traditional claims of the experimental plant.

Pectus excavatum repair from a plastic surgeon's perspective

Minimally invasive repair of pectus excavatum (MIRPE) or similar procedures for pectus excavatum (PE) repair, nowadays no longer performed by one single speciality, may not always achieve sufficient aesthetic results, particularly in the infrapectoral or infraxiphoidal region. Reasons for this include the diaphragm inhibiting correct positioning of the bars, as well as asymmetric deformities which may still be present after remodelling attempts. Furthermore, some cases develop a mild recurrence or partial concavity once the correction bar is removed. However, any secondary re-do MIRPE procedure remains risky because of adhesions between the pleura, lung, pericardium, thoracic wall as residuals from the primary intervention. Treatment options as secondary correction for these deformities may include open access surgery, resection or reshaping of deformed costal cartilage. Moreover, augmentation of a residual concave area can be achieved by autologous transplantation of resected over-abundant cartilage, as well as by liposhifting or implantation of customized alloplastics. A physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques in order to provide the best options for a variety of expressions of anterior wall deformities. Among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. An appropriate technique, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be selected carefully based on the heterogeneity of symptoms, severity, expectations and surgical skill in addition to the available equipment. Out of a variety of such ancillary procedures available and based on experience within general plastic reconstructive surgery, some techniques for PE repair are explained and illustrated here with their advantages and disadvantages.

Evaluation of sternochondroplasty efficacy in treatment of pectus deformities

PURPOSE

This study aimed to evaluate the efficacy of sternochondroplasty for repair of pectus deformities.

METHODS

Thirty-three patients underwent repair of pectus deformity with a sternochondroplasty technique between 1989 and 2009. Studied variables were age, sex, symptoms, pulmonary function tests before and after surgery, Haller index, complications, recurrence, and cosmetic results.

RESULTS

The median age at operation was 13.27 years. Twenty patients (13 male and 7 female) had pectus excavatum, and 13 (11 male and 2 female) had pectus carinatum. Congenital anomalies associated with pectus excavatum included a skeletal anomaly in 6 (30%) patients and a cardiac anomaly in 4 (20%); only 1 patient with pectus carinatum had cardiac anomaly. Inspiratory vital capacity and forced expiratory volume in 1 s were significantly different before and after surgery in patients with pectus excavatum, but there was no significant difference in functional residual capacity. Pulmonary function tests showed no significant differences before and after surgery in patients with pectus carinatum. Complications after surgery were seroma in 2 cases and 1 case each of pneumothorax and atelectasis. Recurrence was observed in 2 cases of pectus excavatum. The cosmetic result was excellent in 93.9% of cases. Hospital mortality was zero.

CONCLUSION

Sternochondroplasty is a desirable procedure for repairing pectus deformities. This procedure has minimal complications and the cosmetic and physiologic results are excellent.