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Yoo G, Jeon HH, Rha EY, Ko JG, Baek SO, Lee JY, Jeong JY. The changes of distance between nipples following correction of women pectus excavatum. Sci Rep 2023; 12:20265. [PMID: 36624098 PMCID: PMC9829671 DOI: 10.1038/s41598-022-24768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
The breasts in women pectus excavatum patients frequently appear to be slanting medially along the inclination of the distorted ribs. This study aims to evaluate changes in the distance between the nipples and to find out whether medially slanting breasts are corrected in women pectus excavatum patients following modified Nuss procedure. This case series analysis enrolled 22 young women patients with pectus excavatum between October 2011 and September 2020. We measured all the patients' distances from the sternal midline to the right and left nipples, based on chest computerized tomography. We calculated the distances between nipples as being the sum of the right and left distances. The mean age of patients was 16.50 ± 4.73 years, and the follow-up periods were 35.59 ± 20.23 months. The postoperative Haller indices (2.89 ± 0.43) were significantly lower than the preoperative Haller indices (5.14 ± 1.96) (p = 0.000). The distances between the nipples before and after Nuss procedure were 145.17 ± 17.73 mm and 172.29 ± 19.11 mm, which is a significant increase following surgery. (p = 0.000). Our results demonstrated that skeletal correction with modified Nuss procedure in pectus excavatum increased the distance between nipples, indicating that medially slanting breasts had been corrected.
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Affiliation(s)
- Gyeol Yoo
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hui Hyung Jeon
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Young Rha
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Gul Ko
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Oon Baek
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Yong Lee
- grid.411947.e0000 0004 0470 4224Department of Plastic and Reconstructive Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- grid.411947.e0000 0004 0470 4224Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-Ro, Bupyeong-Gu, Incheon, Seoul, 21431 Republic of Korea
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Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4028. [PMID: 35028253 PMCID: PMC8747596 DOI: 10.1097/gox.0000000000004028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Since 1994, we have used soft silicone blocks sculpted intraoperatively to correct pectus excavatum in male patients. This technique involves a horizontal access incision in the region of the lower edge of the sternum. During the dissection to expose the sternum, we observed a constant diastasis of the rectus abdominis muscle and changes of the anatomy at its superior insertion. There is no report on this association. Methods Male patients with untreated medial pectus excavatum with indication for silicone block correction were enrolled. Age, weight, height, and the presence of other associated conditions were noted. Ultrasound examination was performed. During the surgery, the width of the linea alba was evaluated and the anatomical positioning of the insertion of rectus abdominis muscle was noted. Results From 2017 to 2019, 10 patients were submitted to surgery. The mean age was 27 years. All patients presented diastasis at the preoperative physical examination. Imaging examination reports showed diastasis of the rectus abdominis muscle: seven partial epigastric separations and three total separations, two of which were associated with umbilical hernia. The intraoperative findings showed the line alba with a minimum of 23 mm and a maximum of 45 mm width at 4 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches with a distance ranging from 35 mm to 60 mm. Conclusions This study confirms the anatomical alterations of the superior portion of the rectus abdominis muscle. The authors discuss the surgical consequences and suggest that the semiology of rectus abdominis muscle is an important preoperative action in pectus excavatum patients.
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HAJE DAVIDEPODESTÁ, HAJE SYDNEYABRÃO, VOLPON JOSÉBATISTA, SILVA ANACAROLINAOLIVEIRADA, LIMA LEONARDOFERREIRABRAZ, HUANG WILSON. LOCALIZED PECTUS EXCAVATUM TREATED WITH BRACE AND EXERCISE: LONG TERM RESULTS OF A BRAZILIAN TECHNIQUE. ACTA ORTOPEDICA BRASILEIRA 2021; 29:143-148. [PMID: 34290561 PMCID: PMC8266278 DOI: 10.1590/1413-785220212903241550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022]
Abstract
Objective: Pectus excavatum is a deformity that affects aesthetics and causes emotional disorders. Surgical correction is well established, but conservative treatment is less common. We investigated the long-term results of using a brace and performing specific physical exercises to treat localized pectus excavatum, a type of deformity in which the depressed area is restricted to the midline region along the nipple line. Methods: We selected 115 patients (mean age 12.8 years), with a minimum follow-up of 36 months, who were evaluated more than one year after the end of treatment and skeletal maturity. Results were correlated with deformity flexibility, severity, regular use of the device, and performance of specific exercises. The chi-square (χ2) and the Cochran-Mantel-Haenszel tests were used for statistical analysis. Results: Treatment was successful in 58% of patients, however, when exercises were performed and the brace was used regularly by patients with flexible deformities, the rate increased to 83% (p = 0.005). Severity and adherence to treatment greatly impacted successful treatment (p = 0.009 and < 0.001, respectively). Conclusion: The proposed treatment method was effective for correction or partial correction of the deformity in motivated patients followed up until skeletal maturity, especially when started early in milder and more flexible deformities. Level of Evidence V, Expert opinion.
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Affiliation(s)
- DAVI DE PODESTÁ HAJE
- Centro Clínico Orthopectus, Brazil; Hospital de Base do Distrito Federal, Brazil
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Caro C, Freude W, Florek A, Morgenstern S, Boeer B, Roehm C, Hahn M, Marx M. Simultaneous correction of a pectus excavatum with tubular breast deformity using a custom-made silicone implant. Arch Gynecol Obstet 2021; 303:1025-1037. [PMID: 33389096 DOI: 10.1007/s00404-020-05898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Pectus excavatum (PE) is one of the most common congenital deformities of the thorax and is characterized by a depressed sternum with reduction of the antero-posterior thoracic diameter. Although the majority of patients with PE have no physiologic limitations, it is often associated with psychological problems influencing the patients' quality of life. Surgical treatment options show particular variation with regard to invasiveness and morbidity of the respective procedures. Surgical treatment using a custom-made silicone implant represents a less invasive alternative for patients without further accompanying physical symptoms. This article describes the simultaneous correction of a PE combined with tubular breast deformity using this minimally invasive technique.
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Affiliation(s)
- C Caro
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - W Freude
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - A Florek
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - S Morgenstern
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - B Boeer
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - C Roehm
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Hahn
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany.
- Department of Women's Health, University of Tübingen, Tübingen, Germany.
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Hedén P, Sinna R. An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment. Aesthet Surg J 2019; 39:NP189-NP201. [PMID: 30388191 PMCID: PMC6520969 DOI: 10.1093/asj/sjy303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Pectus 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. Objectives The 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. Methods Males ≥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. Results The 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. Conclusions Treatment 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
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Affiliation(s)
| | - Raphael Sinna
- Department of Plastic Reconstructive and Aesthetic Surgery, University Hospital Amiens, Amiens, France
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Wu Y, Chen N, Xu Z, Zhang X, Liu L, Wu C, Zhang S, Song Y, Wu T, Liu H, Tang M, Wu W. Application of 3D printing technology to thoracic wall tumor resection and thoracic wall reconstruction. J Thorac Dis 2018; 10:6880-6890. [PMID: 30746234 DOI: 10.21037/jtd.2018.11.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Thoracic wall tumors can leave large defects in the thoracic wall after tumor resection. Currently, the shape of the materials commonly used for thoracic wall repair, including dacron mesh and titanium alloy mesh, cannot readily conform to the shapes of defect sites. In this study, we aimed to retrospectively review and evaluate the outcomes of applying three-dimensional (3D) printing technology in assisting in thoracic wall tumor resection and thoracic wall construction. Methods Six patients with thoracic wall tumors underwent thin-slice CT scanning. We 3D reconstructed pleural tumors and adjacent structures with Amira software and 3D printed them. Preoperative simulation, surgical rehearsal, and surgical planning were performed, and 3D conformal titanium plates were created based on 3D reconstruction models and sutured to the defect sites of the thoracic wall. We also retrospectively reviewed 10 patients who underwent this surgery with conventional methods. All of the demographic data, clinical data, and laboratory findings (non-normally distributed variables) were compared between these two groups. Results 3D reconstructions of the tumors and their adjacent structures were successfully performed, and 3D printing physical models and conformal titanium plates were also successfully obtained. The plate afforded accurate matching, less bleeding, fewer postoperative complications, and less pain. Conclusions This 3D printing technology can aid in preoperative rehearsal, surgical planning, and the manufacturing of 3D implants. The 3D titanium plate has such advantages over traditional implants as having good fit and hardness, improving the surgical accuracy and curative effect, and reducing complications, such as bleeding and pain.
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Affiliation(s)
- Yi Wu
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Na Chen
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Zhou Xu
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Xiaoqin Zhang
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Li Liu
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Chunling Wu
- Institute of Medical Imaging, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Shaoxiang Zhang
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Yan Song
- Institute of Digital Medicine, Biomedical Engineering College, Third Military Medical University, Chongqing 400038, China
| | - Tao Wu
- Department of Cardiothoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hongxiang Liu
- Department of Cardiothoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Meng Tang
- Department of Cardiothoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wei Wu
- Department of Cardiothoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Tilliet Le Dentu H, Lancien U, Sellal O, Duteille F, Perrot P. [Contribution of computer-aided design for the conception of custom-made implants in Pectus Excavatum surgical treatment. Experience of the Nantes plastic surgery unit]. ANN CHIR PLAST ESTH 2017; 63:1-10. [PMID: 29246660 DOI: 10.1016/j.anplas.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pectus excavatum is the most common congenital chest malformation and is a common reason for consultation in plastic surgery. Our attitude is most often a filling of the depression with a custom-made silicone prosthesis. The objective of this work was to evaluate the interest of computer-aided design (CAD) of implants compared to the conventional plaster molds method. PATIENTS AND METHODS We have collected all the cases of custom-made silicone implants to treat funnel chests in our plastic surgery department. The quality of the results was evaluated by the patient, and in a blind manner by the surgical team using photographs and standardized surveys. The pre-operative delays, the operating time and length of hospital stays, the number of surgical recoveries, and the post-operative surgical outcomes were recorded. RESULTS Between 1990 and 2016, we designed 29 silicone thoracic implants in our department. Before 2012, implants were made from plaster chest molds (n=13). After this date, implants were designed by CAD (n=16). Patients rated their results as "good" or "excellent" in 77% and 86% of cases respectively in the plaster and CAD groups. The surgical team's ratings for CAD implant reconstructions were better than in the plaster group: 8.17 versus 6.96 (P=0.001). CAD implants were significantly less detectable than the plaster group implants. The operating time was reduced in the CAO group: 60.2 compared to 74.7minutes in the plaster group (P=0.04), as was the length of hospitalization: 3.5 versus 5.3 days (P=0.01). There were no significant differences between the two groups in terms of post-operative complications. CONCLUSION The management of pectus excavatum by a custom-made silicone implant is a minimally invasive method that provides good cosmetic results. The design of these implants is facilitated and qualitatively improved by CAD.
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Affiliation(s)
- H Tilliet Le Dentu
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - U Lancien
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - O Sellal
- Pharmacie centrale, hôpital Saint-Jacques, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France.
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Lipińska J, Kutwin L, Wawrzycki M, Olbrzymek L, Jabłoński S. Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium. Onco Targets Ther 2017; 10:4099-4103. [PMID: 28860818 PMCID: PMC5566894 DOI: 10.2147/ott.s135681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Resection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization. Aim The purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum. Case We present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene. Results Sternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence. Conclusion Custom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location.
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Affiliation(s)
- Joanna Lipińska
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
| | - Leszek Kutwin
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
| | - Marcin Wawrzycki
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
| | | | - Sławomir Jabłoński
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
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Periareolar Access for Pectus Excavatum Correction with Silicone Implants: A New Method to Minimize Postoperative Scars-Review of the Literature, Considerations and Statistical Analysis of Clinical Outcomes. Aesthetic Plast Surg 2017; 41:878-886. [PMID: 28374301 DOI: 10.1007/s00266-017-0863-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pectus excavatum (PE) is one of the most frequent thoracic malformations. Generally, the malformation is not associated with functional disorders and often constitutes an aesthetic alteration with significant psychological distress. OBJECTIVES To reduce the visibility of the residual scarring produced by corrective surgery and to improve the aesthetic outcome, the authors propose a new prosthetic implant technique through a periareolar access. METHODS From January 2005 to January 2015, 11 patients affected with PE underwent the surgical procedure with a sternal prosthesis implanted through a periareolar access with the help of a fiberscope. The preoperative evaluation of the perception of the malformation and postoperation results were made using different questionnaires. The data collected in our series were compared with that reported in 4 different papers where other forms of access were used: sternal, inframammary and transumbilical. RESULTS No major complications or dislocation of the implants were reported. Among the complications, 6 postoperative seromas were reported. The patients' perception of improvement through the use of 2 questionnaires and an evaluation scale showed substantial improvement in all the aesthetic outcomes. CONCLUSIONS The periareolar technique provides excellent cosmetic results compared to the sternal one. This access causes fewer complications and necessitates a shorter average hospital stay than the sternum access. To conclude, according to what is shown in the literature, periareolar access seems to be a quicker procedure, requiring a shorter stay in hospital, and results in scars that can more easily be hidden and are more accepted by patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Contributions of Combined Techniques in the Personalized Treatment of Pectus Excavatum. Plast Reconstr Surg 2016; 139:321e-322e. [PMID: 27643418 DOI: 10.1097/prs.0000000000002883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice? Wideochir Inne Tech Maloinwazyjne 2016; 11:98-104. [PMID: 27458490 PMCID: PMC4945611 DOI: 10.5114/wiitm.2016.60456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. AIM To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. MATERIAL AND METHODS Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2-45 years). There were 236 adult patients (28.2%) (> 18 years) - 20 female, 216 male. The mean age among the adult patients was 23.2 years (18-45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. RESULTS The MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25-90 min). The median postoperative stay was 4.92 ±2.81 days (3-21 days) in adults and 4.64 ±1.58 (2-13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). CONCLUSIONS MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults.
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Iyer AR, Powell DK, Irish RD, Math KR. Pectus excavatum with delayed diagnosis of implant tear on MRI apparently causing recurrent postoperative seromas: A case report. Skeletal Radiol 2015; 44:1153-6. [PMID: 25452151 DOI: 10.1007/s00256-014-2060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/31/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
Seroma formation is the most common early postoperative complication after pectus excavatum repair, but later seromas are rare. While many seromas eventually resorb or decrease in size after aspiration, our case demonstrates recurrent seroma formation as a late complication of pectus excavatum repair in a patient with an implant tear. Postoperative seromas can result in prolonged chest wall pain, large chest wall masses, and increased mass effect on the heart with potential risk for resultant right ventricular outflow obstruction. This case report illustrates a solid silicone implant tear. Though rare, early recognition may help to decrease the likelihood of recurrent postoperative seromas.
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Affiliation(s)
- Arti R Iyer
- Department of Radiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA,
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Soccorso G, Parikh DH, Worrollo S. Customized silicone implant for the correction of acquired and congenital chest wall deformities: A valuable option with pectus excavatum. J Pediatr Surg 2015; 50:1232-5. [PMID: 25957023 DOI: 10.1016/j.jpedsurg.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/12/2015] [Accepted: 04/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical remodeling and correction of congenital and acquired chest wall deformities (CWD) is undertaken many times for cosmesis. Although reportedly minimally invasive, commonly used Nuss procedure for correction of pectus excavatum (PE) is not without complications. Nuss procedure is also not suitable for complex deformities and Poland syndrome cases. Insertion of custom-made silicone implants for the reconstruction of defects has been adopted from adult plastic reconstructive surgery as primary repair of CWD or rescue procedure for recurrence of PE after recurrence or residual deformity. METHODS We present our experience with CWD reconstruction in children with customized silicone prosthesis made from a surgically implantable liquid silicone rubber (NuSil MED-4805, Ca). RESULTS Since 2006 we treated 26 patients with CWD: six were children (age <17years, median 14.6) with PE. Implants were custom made for each patient's chest. The implants were inserted under general anesthesia. Postoperatively all patients were fully satisfied with the cosmetic result and subjective patient satisfaction remained excellent at follow-up in all the children. Only one child developed postoperative complications (seroma). CONCLUSIONS Customized silicone implant for PE in the pediatric age is an alternative therapeutic method, as primary or rescue treatment, with equally good cosmetic outcome, fewer significant complications, less postoperative pain and a faster recovery.
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Affiliation(s)
- Giampiero Soccorso
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom.
| | - Dakshesh H Parikh
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Steve Worrollo
- Maxillofacial Prosthetics Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Zou X, Lin Y, Jin H, Cai S, Xu X, Yin W, Geng Q, Chen J, Liang B, He J, Li W. Screening for pectus excavatum among primary students and establishment of a pectus excavatum screening program in Dongguan, China. J Thorac Dis 2015; 7:868-74. [PMID: 26101642 PMCID: PMC4454853 DOI: 10.3978/j.issn.2072-1439.2015.04.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/19/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To carry out pectus excavatum (PEx) screening among primary school students in Dongguan, with an attempt to establish a PEx screening program and provide epidemiological evidences for developing guidelines on the diagnosis and treatment of PEx for young children. METHODS A total of 479,402 primary school students who were already in school in 2012 or newly enrolled in 2013 from 422 primary schools in 32 towns in Dongguan, Guangdong Province were screened for PEx. Meanwhile, about 420 medical staff from the infirmaries of 422 primary schools were provided with a serial of training, with an attempt to establish a PEx screening program and network. RESULTS Valid screening results were obtained from 477,627 pupils (99.62%) from 406 primary schools in 31 towns. These students aged 4-15 years (mean: 8.78 years), among whom there were 244,545 males (N1; mean age: 8.22 years) and 233,082 females (N2; mean age: 8.89 years). Totally 257 PEx patients were identified, yielding a prevalence of 0.583%, among whom there were 176 males (N3; mean age: 8.79 years) and 81 females (N4; mean age: 8.77 years). With the PEx patients as the PEx group and the healthy children as the control group, chi square test with gender as the dependent variable showed that the incidence of PEx was significantly different between male and female students (P=0.00) (N3:N4 =2.172:1). In addition, 410 medical staff from the school infirmaries were trained, and a PEx screening program and network was established. CONCLUSIONS The screening for PEx was successfully performed among pupils who were already in school in 2012 or newly enrolled in 2013 from 422 primary schools in Dongguan, Guangdong Province. Statistical analysis showed that the incidence of PEx differed between male and female pupils. A stable effective PEx screening program was established, which will provide personal and technical supports for the early diagnosis and treatment of this condition.
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Pectus excavatum in adult women: repair and the impact of prior or concurrent breast augmentation. Plast Reconstr Surg 2015; 135:303e-312e. [PMID: 25626815 DOI: 10.1097/prs.0000000000000990] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women present with pectus excavatum five times less frequently than men. Adult women may have additional, associated cosmetic factors, including hypoplastic or asymmetric breasts, or prior augmentation. The authors evaluated the impact of prior or concurrent cosmetic breast surgery in an adult female cohort undergoing repair of pectus excavatum deformity. METHODS A retrospective review was performed of women (≥18 years old) who underwent pectus excavatum repair at a single institution from January of 2010 to September of 2013. RESULTS Pectus excavatum repair was performed on 47 women with a median age of 35 years (range, 18 to 63 years). Mean pectus severity index was 6.2 (range, 3.1 to 16). All patients had physiologic symptoms as the primary purpose for seeking repair. Twenty patients (43 percent) presented with existing implants or the desire for implants at the time of repair. Fifteen patients (32 percent) had a history of implant placement including prior breast augmentation (n = 14) and/or pectus implant (n = 4). Concurrent augmentation (n = 5), breast implant exchange (n = 8), and/or removal of chest wall implants (n = 4) was performed during repair. Morbidity included one implant-related hematoma. Complications and hospital stay were not significantly different for patients undergoing primary repair alone versus those with prior or concurrent augmentation. CONCLUSIONS Breast cosmesis was a concern in nearly half of adult women presenting for pectus excavatum repair. The authors' experience suggests neither prior nor concurrent breast augmentation increases the risk of complications in repair. The authors recommend that cosmetic breast surgery be performed concurrently with pectus excavatum repair. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Anger J, Alcalde RFV, de Campos JRM. The use of soft silicone solid implant molded intraoperatively for pectus excavatum surgical repair. EINSTEIN-SAO PAULO 2014; 12:186-90. [PMID: 25003924 PMCID: PMC4891161 DOI: 10.1590/s1679-45082014ao2919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/25/2014] [Indexed: 11/21/2022] Open
Abstract
Objective: To describe a new surgical technique to treat pectus excavatum utilizing low hardness solid silicone block that can be carved during the intraoperative period promoting a better aesthetic result. Methods: Between May 1994 and February 2013, 34 male patients presenting pectus excavatum were submitted to surgical repair with the use of low hardness solid silicone block, 10 to 30 Shore A. A block-shaped parallelepiped was used with height and base size coinciding with those of the bone defect. The block was carved intraoperatively according to the shape of the dissected space. The patients were followed for a minimum of 120 days postoperatively. The results and the complications were recorded. Results: From the 34 patients operated on, 28 were primary surgeries and 6 were secondary treatment, using other surgical techniques, bone or implant procedures. Postoperative complications included two case of hematomas and eight of seromas. It was necessary to remove the implant in one patient due to pain, and review surgery was performed in another to check prothesis dimensions. Two patients were submitted to fat grafting to improve the chest wall contour. The result was considered satisfactory in 33 patients. Conclusion: The procedure proved to be fast and effective. The results of carved silicone block were more effective for allowing a more refined contour as compared to custom made implants.
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Affiliation(s)
- Jaime Anger
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Johnson WR, Fedor D, Singhal S. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg 2014; 9:25. [PMID: 24506826 PMCID: PMC3922335 DOI: 10.1186/1749-8090-9-25] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 02/04/2014] [Indexed: 11/16/2022] Open
Abstract
This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric=0-21; adult 17-99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation.
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Affiliation(s)
- William Rainey Johnson
- Department of Surgery, Thoracic Surgery Research Laboratory, Perelman School of Medicine, Philadelphia, PA, USA
| | - David Fedor
- Department of Surgery, Thoracic Surgery Research Laboratory, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sunil Singhal
- Department of Surgery, Thoracic Surgery Research Laboratory, Perelman School of Medicine, Philadelphia, PA, USA
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Wallmichrath J, Baumeister RG, Giunta RE, Holzbach T, Frick A. Correction of asymmetric pectus excavatum using a virtually designed silicone implant. Aesthetic Plast Surg 2014; 38:146-150. [PMID: 24310582 DOI: 10.1007/s00266-013-0244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 11/07/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND An extended asymmetric funnel chest deformity with the breast gland located in the thoracic mold can lead to a fictitious aplasia of the breast. The authors termed this condition "pseudo-Amazon syndrome" because the breast tissue and the pectoralis muscle are fully developed. METHODS This report presents a detailed technical approach to the fabrication of a precise-fitting custom-made silicone implant. The design of the implant was achieved using a computed tomography (CT) data set and rapid prototyping. The volumes of the "hidden" and the normal breasts measured preoperatively by processing the CT data were similar. These volumes were compared with the breast volumes measured by three-dimensional photography 4 years postoperatively to assess the predictability of the volume congruency. The silicone implant was surgically placed in the epicostal plane and extended almost over the right hemithorax. RESULTS The implantation was performed without the necessity of further trimming. Both the surgeon and the patient rated the aesthetic and functional long-term result as good in terms of symmetry and the possibility of exercise without restrictions. The final breast volume of the surgically treated side was 95 % of the volume of the normal contralateral breast. CONCLUSION The described method reduces the operation time and the operative trauma by primary implant fit. However, the method is rather elaborate and the production process is expensive. This in turn reduces the generation of proceeds to a minimum. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jens Wallmichrath
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | | | - Riccardo E Giunta
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Holzbach
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andreas Frick
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
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Ho Quoc C, Delaporte T, Meruta A, La Marca S, Toussoun G, Delay E. Breast asymmetry and pectus excavatum improvement with fat grafting. Aesthet Surg J 2013; 33:822-9. [PMID: 23908301 DOI: 10.1177/1090820x13493907] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In women, pectus excavatum malformation can cause modified breast morphology, resulting in mammary asymmetry, which can be increased by placing mammary implants alone. Fat transfer can be an elegant solution to increase the volume and projection of the breast. OBJECTIVES The authors discuss their experience treating pectus excavatum with fat transfer (lipomodeling) since 2000. METHODS The charts of 19 consecutive patients with a pectus excavatum breast asymmetry who underwent lipomodeling treatment at the authors' facility between January 2000 and November 2011 were retrospectively reviewed. Patients were separated using the Chin classification (type 1, 2, and 3). Data points for each patient included age and body mass index, number of interventions and volume of fat injected during each session, total volume transferred, and postoperative complications. The clinical result was evaluated by the patient and the surgical team on a 4-point scale: very good, good, fair, or poor. RESULTS Most (74%) patients in this series had type 3 Chin pectus excavatum. The average age was 28 years, and the average body mass index was 20.3. The average number of lipomodeling sessions was 1.63, and the average volume of fat transferred was 230 mL per session and 375 mL total. The patients and the surgical team were very satisfied or satisfied in 95% of cases and considered the result fair in 5% of cases. There were no complications. CONCLUSIONS Fat transfer for treatment of pectus excavatum yields very good (natural and stable) results and high patient satisfaction rates, which makes this technique our preferred method for treating thoracomammary malformations in pectus excavatum.
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Affiliation(s)
- Christophe Ho Quoc
- Department of Plastic and Reconstructive Surgery, Centre Régional Léon Bérard, 28 rue Leannec, Lyon, France.
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Ho Quoc C, Chaput B, Garrido I, André A, Grolleau JL, Chavoin JP. Correction des asymétries mammaires associées au pectus excavatum primaire. ANN CHIR PLAST ESTH 2013; 58:54-9. [DOI: 10.1016/j.anplas.2012.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/10/2012] [Indexed: 11/16/2022]
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Use of Macrolane to Treat Pectus Excavatum. Ann Thorac Surg 2012; 93:e17-8. [DOI: 10.1016/j.athoracsur.2011.09.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/10/2011] [Accepted: 09/15/2011] [Indexed: 11/18/2022]
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Schwabegger AH, Piza-Katzer H, Pauzenberger R, Del Frari B. The internal mammary artery perforator (IMAP) breast-flap harvested from an asymmetric hyperplastic breast for correction of a mild funnel chest deformity. Aesthetic Plast Surg 2011; 35:928-32. [PMID: 21461629 DOI: 10.1007/s00266-011-9697-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 02/28/2011] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Anton H Schwabegger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
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