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Sargent B, Bolanos D, Garcia V, Howell L. An Aggregate Sternal Force-Deflection Model. J Biomech Eng 2023; 145:111009. [PMID: 37565991 DOI: 10.1115/1.4063148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
Understanding the force-deflection behavior of the sternum is an important element in designing devices for implants for chest wall deformity repair. Human growth and variability makes a single measure of the stiffness difficult to determine. This work takes empirical data from the literature to develop aggregate sternal force-deflection models. Statistical methods were used to determine possible groupings based on patient age and the effect of gender. It was found that three age groups could be used, representing childhood (4-10 years), adolescence (11-19 years), and adulthood (26-53 years). Gender was found to have a statistical p-value of 0.068, 0.0611, and 0.012, respectively, in the proposed age groups. Jittering of the data was used to account for human variability and assumptions made in data comparisons. The jittered results followed that of the initial dataset. Childhood force-deflection behavior follows a relatively constant stiffness, adolescence experiences a growth period of increasing stiffness, and adulthood stiffnesses again begin to stabilize around a relatively constant value.
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Affiliation(s)
- Brandon Sargent
- Department of Mechanical Engineering, Gonzaga University, Spokane, WA 99258
| | - Diana Bolanos
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
| | - Victor Garcia
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - Larry Howell
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
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Geraedts TCM, Daemen JHT, Vissers YLJ, Hulsewé KWE, Van Veer HGL, Abramson H, de Loos ER. Minimally invasive repair of pectus carinatum by the Abramson method: A systematic review. J Pediatr Surg 2022; 57:325-332. [PMID: 34969524 DOI: 10.1016/j.jpedsurg.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this review is to provide an overview of the outcomes after minimally invasive pectus cartinatum repair (MIRPC) by the Abramson method to determine its effectiveness. METHODS The PubMed and Embase databases were systematically searched. Data concerning subjective postoperative esthetic outcomes after initial surgery and bar removal were extracted. In addition, data on recurrence, complications, operative times, blood loss, post-operative pain, length of hospital stay, planned time to bar removal and reasons for early bar removal were extracted. The postoperative esthetic result, was selected as primary outcome since the primary indication for repair in pectus carinatum is of cosmetic nature. RESULTS Six cohort studies were included based on eligibility criteria, enrolling a total of 396 patients. Qualitative synthesis showed excellent to satisfactory esthetic results in nearly all patients after correctional bar placement (99.5%, n = 183/184). A high satisfaction rate of 91.0% (n = 190/209) was found in patients after bar removal. Recurrence rates were low with an incidence of 3.0% (n = 5/168). The cumulative postoperative complication rate was 26.5% (n = 105/396), of whom 25% required surgical re-intervention. There were no cases of mortality. CONCLUSIONS Minimally invasive repair of pectus carinatum through the Abramson method is effective and safe. Its efficacy is demonstrated by the excellent to satisfactory esthetic results in 99.5% and 91.0% of patients after respectively correctional bar placement and implant removal. Future studies should aim to compare different treatment options for pectus carinatum in order to elucidate the approach of choice for different patient groups.
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Affiliation(s)
- Tessa C M Geraedts
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Hans G L Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; BREATHE Laboratory, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Horacio Abramson
- Surgical Thoracic Service, Hospital Antonio Cetrángolo, Vicente Lopez, Buenos Aires, Argentina
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.
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Skrzypczak P, Kasprzyk M, Piwkowski C. The new steel bar in pectus carinatum repair and a review of current methods of correcting chest deformations. J Thorac Dis 2022; 14:3671-3673. [PMID: 36389318 PMCID: PMC9641324 DOI: 10.21037/jtd-22-956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/28/2022] [Indexed: 08/30/2023]
Affiliation(s)
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Edward KR, John OR, Jay GM, Ann KM, Mary MM, Stopp DD, Khrisna PH, Woodrow FF. Ten-year experience with staged management of pectus carinatum: Results and lessons learned. J Pediatr Surg 2021; 56:1835-1840. [PMID: 33558070 DOI: 10.1016/j.jpedsurg.2021.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We report pectus carinatum management over a 10+year period. METHODS Staged management, with initial bracing and operation for failure or special circumstances, was employed. A newer brace and a minimally invasive operation for PC (the Abramson procedure) were introduced during the study period. RESULTS Of 695 consenting patients from 2008 to 2018, 265 (38%) were observed. Of 430 treated, 339 (79%) had bracing only; 65 (15%) underwent surgery without a trial of bracing, while 26(5%) underwent surgery after a failed attempt at bracing. Of 364 bracing patients, 144 (40%) were successful, 77 (21%) are ongoing, 25 (7%) failed, and 118 (32%) dropped out. Recurrence was noted in 17 (5%), an average 5.4 months later. Two (0.4%) overcorrected to pectus excavatum (PE). Successful patients experienced a 50% decrease in pressure of correction (POC) beginning one month after starting treatment. Brace failure patients did not. Reported compliance with brace utilization (hours/day) was similar. Surgery was required in 91 patients. Open operations were performed in 61 (67%), Abramson operations in 23 (25%), and Nuss procedure in 7 (8%) who developed excavatum over correction following bracing or who had mixed deformity, with excavatum one side of the sternum and carinatum on the other. Twenty-four (36%) of the surgeries for PC occurred after an attempt at bracing. All obtained good initial results by operation. No recurrence was noted after open operation and 3 (13%) after Abramson. Open complications included 1 (2%) infection. Abramson's operation required 11 (48%) revisions, 6 (26%) early bar removals, and had 3 (13%) infections. CONCLUSION Brace treatment for PC can be guided by pressure of correction, which fell by more than half in successfully treated patients. POC did not fall in patients who failed. If POC does not fall, surgery should be considered. Open repair of Pectus Carinatum is generally successful, while the Abramson operation has a significant rate of complications with the implants currently available in the U.S. LEVELS OF EVIDENCE Level III - Retrospective comparative study.
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Affiliation(s)
- Kelly Robert Edward
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School.
| | - Obermeyer Robert John
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School
| | - Goretsky Michael Jay
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School
| | - Kuhn Marcia Ann
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School
| | - McGuire Margaret Mary
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School
| | - Duke Duane Stopp
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School
| | - Pallera Haree Khrisna
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA
| | - Frantz Frazier Woodrow
- Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School
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Wang L, Liu J, Shen S, Li Y, Feng T, Li G, Xiao H, Hu F. Comparison of Outcomes Between Anti-Nuss Operation and Modified Anti-Nuss Operation Using a Flexible Plate for Correcting Pectus Carinatum: A Retrospective Study. Front Surg 2021; 7:600755. [PMID: 33659269 PMCID: PMC7920095 DOI: 10.3389/fsurg.2020.600755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: The anti-Nuss procedure has gradually been found to have several shortcomings in clinical practice. Accordingly, our department previously designed and introduced a new steel plate. However, there is limited evidence regarding its safety and efficacy. Thus, we aim to compare the efficacy and safety of the conventional anti-Nuss operation with those of a modified anti-Nuss operation using a flexible plate. Methods: Patients with pectus carinatum who underwent surgery between January 2014 and August 2019 were consecutively enrolled in this single-center, retrospective study. In all, 53 patients underwent the modified procedure using the new steel plate (new procedure group), whereas 43 underwent the conventional anti-Nuss procedure (traditional procedure group). Outcome analysis was performed using SPSS to compare the intraoperative and postoperative short-term outcomes. Results: All patients in the new procedure group had shorter operation duration (75.23 ± 11.90 vs. 82.45 ± 9.30 min, p = 0.008), postoperative hospitalizations (3.42 ± 0.95 vs. 4.64 ± 1.53 days, p = 0.039), and plate removal surgery durations (40.60 ± 3.47 vs. 60.30 ± 9.75 min, p = 0.041) than patients in the traditional procedure group. There were no significant differences in the length of incision, postoperative Haller index, cost, postoperative surgical outcome, and incidence of complications between the two groups. Conclusion: Our data reveal that the main clinical outcomes were similar for after anti-Nuss operation and modified anti-Nuss operation. However, the modified procedure for pectus carinatum had a shorter operation duration, postoperative hospitalization, and plate removal surgery duration.
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Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Nursing, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Saie Shen
- Department of Anesthesiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao Li
- Department of Disaster and Emergency Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Guoqing Li
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Xiao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengqing Hu
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Skrzypczak P, Kamiński M, Pawlak K, Piwkowki C. Seasonal interest in pectus excavatum and pectus carinatum: a retrospective analysis of Google Trends data. J Thorac Dis 2021; 13:1036-1044. [PMID: 33717576 PMCID: PMC7947486 DOI: 10.21037/jtd-20-2924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Individuals affected by chest wall deformities may search for information on these conditions on the web. Google data may reflect the global interest in health-related information. Our aim was to investigate the global trends in searches associated with the topics “Pectus excavatum” and “Pectus carinatum” using Google Trends. Methods We retrieved the global data from 1st January 2004 to 31st October 2019. We analyzed the relative search volume (RSV) for countries or areas with a no-low search volume. We compared differences in interest between seasons using the Kruskal-Wallis test with the post-hoc test. Results The median RSV for the pectus excavatum was equal to 58.00 (54.00–65.00) while for pectus carinatum 28.00 (23.25–31.00). The interest in pectus excavatum decreases on average by 0.98 RSV each year, while interest in pectus carinatum increased each year by 0.87 RSV. We observed the highest interest in analyzed topics during summer and the lowest during winter. The relative difference in interest between summer and winter was equal to 21.4% for pectus excavatum and 19.2% for pectus carinatum. Pectus excavatum was the most popular topic in n=51 countries or areas, while pectus carinatum in n=7 countries or areas/regions. Conclusions Globally, interest in pectus excavatum is higher than the interest in pectus carinatum that might reflect real-world prevalence. The interest in both topics shows seasonal variation. The Internet is an essential source of information on chest wall deformities. The medical professionals should provide quality content on pectus excavatum and pectus carinatum.
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Affiliation(s)
- Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Krystian Pawlak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Cezary Piwkowki
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Song IH, Lee SJ, Lee SY. Repair of pectus carinatum, carinatum/excavatum complex patients with doubly double bar technique. Gen Thorac Cardiovasc Surg 2020; 68:1354-1356. [PMID: 32200520 DOI: 10.1007/s11748-020-01339-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Abstract
Surgical correction is needed for patients with pectus carinatum who do not adapt to bracing therapy. We performed the doubly double bar technique for ten patients who did not adapt to bracing therapy for patients with pectus carinatum and/or carinatum/excavatum complex type. A complete correction was achieved for all patients, and there were no complications. Our initial experience suggests that the doubly double bar technique can be performed effectively for pectus carinatum and/or carinatum/excavatum complex type patients.
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Affiliation(s)
- In-Hag Song
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Cheonan Hospital, 31, 6-gil, Soonchunhyang, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, South Korea
| | - Seung Jin Lee
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Cheonan Hospital, 31, 6-gil, Soonchunhyang, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, South Korea.
| | - Seock Yeol Lee
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Cheonan Hospital, 31, 6-gil, Soonchunhyang, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, South Korea
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Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon's 10 years of experience. Gen Thorac Cardiovasc Surg 2018; 66:653-657. [PMID: 30039204 DOI: 10.1007/s11748-018-0975-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008. METHODS Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7 ± 4.8 (3-38) years. Over an 8 years' experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on "compression test". Early follow-up was on postoperative day 15 and 30. RESULTS The mean operative time was 42.1 ± 16.9 min. The mean hospital stay was 4.2 ± 0.9 days. Postoperative complications included pneumothorax (n = 2, 1.9%), wound infection (n = 2, 1.9%), skin perforation (n = 2, 1.9%), intolerable pain (n = 1, 0.9%), skin hyperpigmentation (n = 1, 0.9%), and overcorrection (n = 1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8 ± 4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results. CONCLUSIONS MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.
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