Chest deformity repair

Alternative names
Funnel chest repair; Pectus excavatum repair

Definition
Surgery to correct pectus excavatum, a deformity of the front of the chest wall with depressed breastbone (sternum) and ribs.

Description

There are various surgical approaches for treating this condition. In the most commonly used approach, while the child is deep asleep and pain-free (using general anesthesia), an incision is made over the sternum. The deformed cartilages are removed and the rib lining is left in place to allow the cartilages to regrow.

An incision is made in the sternum and it is repositioned. A rib or metal strut may be used to stabilize the sternum in normal position until healing occurs in 3 to 6 months. A temporary chest tube may be placed to reexpand the lung if the lining of the lung is entered.

Metal struts are removed 6 months later through a small skin incision under the arm. This procedure is usually done on an outpatient basis. Most repairs are done between 18 months and 5 years of age, although there has been debate about the best age for the procedure.

A newer, less invasive approach involves the placement of a curved steel bar beneath the sternum to elevate the deformed sternum and cartilages without removal of any bone or cartilage. The bar is later removed, after two to four years. There are advantages and disadvantages compared to the more invasive approaches, and long-term results with this approach are not yet available.

Indications
Pectus excavatum repair may be recommended for:

     
  • Improved appearance (cosmetic repair)  
  • Improved posture  
  • Improved breathing  
  • Improved exercise capacity

Risks
The risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

The risks for any surgery are:

     
  • Bleeding  
  • Infection  
  • Scarring

Additional risks may include:

     
  • Lung collapse  
  • Recurrence of the deformity

Expectations after surgery
Cosmetic results are generally good. The success of the procedure to improve breathing or exercise capacity is variable. Many affected children have other connective tissue disorders, and thus need related surgery.

Convalescence
Hospitalization for 1 week is common. Vigorous activity may need to be restricted for 3 months.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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