What is Pectus Arcuatum
Surgical correction of pectus arcuatum
Vladimir Kuzmichev, Ksenia Ershova, Ruben Adamyan
Contributions: (I) Conception and design: V Kuzmichev; (II) Administrative support: R Adamyan; (III) Provision of study materials or patients: R Adamyan; (IV) Collection and assembly of data: K Ershova; (V) Data analysis and interpretation: V Kuzmichev; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Background: Pectus arcuatum is a rear congenital chest wall deformity and methods of surgical correction are debatable.
Methods: Surgical correction of pectus arcuatum always includes one or more horizontal sternal osteotomies, resection of deformed rib cartilages and finally anterior chest wall stabilization. The study is approved by the institutional ethical committee and has obtained the informed consent from every patient.
Results: In this video we show our modification of pectus arcuatum correction with only partial sternal osteotomy and further stabilization by vertical parallel titanium plates.
Conclusions: Reported method is a feasible option for surgical correction of pectus arcuatum.
Keywords: Chest wall deformities; pectus arcuatum; Currarino-Silverman syndrome; pouter pigeon chest; surgical correction
Received: January 08, 2016; Accepted: 04 February 2016; Published: 16 March 2016.
doi: 10.21037 / jovs.2016.02.28
Pectus arcuatum (other names pouter pigeon chest, Currarino-Silverman syndrome, chondro-manubrial deformity, type 2 pectus carinatum) is a rear congenital chest wall deformity with main feature being protrusion and early ossification of Sternal (Lewis) angle together with bilateral deformity of 2nd to 4th cartilages (1). Pectus arcuatum is often misdiagnosed as a combination of pectus carinatum and pectus excavatum, however, there is no sternal depression and visual appearance is formed by costal cartilages protrusion.
In majority of cases pectus arcuatum is a pure cosmetic problem (Figure 1). Congenital heart defects are reported occasionally as well as simultaneous Poland syndrome. CT scan with 3-D reconstruction is very informative for surgery planning (Figure 2A other 2 B). Routine preoperative check up is needed. Different opinions exist about age of surgery. Since it is more cosmetic there is no need in early interventions. Due to necessity to resect cartilages late puberty or adulthood is preferred, since by that age the growth of ribs is finished.
Patients are usually young adults without comorbidities and no special preparation is needed.
Equipment preference card
- Basic thoracic instruments set;
- Instruments for cartilages / ribs / sternum resection (bone elevators, rongeurs, chisel and hummer or power saw);
- Titanium locking 2.4 mm reconstructive plates with self-tapping bicortical screws (DePuy Synthes, Switzerland).
General anesthesia, endotracheal, epidural catheter for postoperative analgesia.
Supine position with hands aside.
Steps of procedure:
- Incision: submammarian in females and vertical midline in males;
- Musculocutaneous flaps are raised till the level of sternal notch;
- Subperichondrial bilateral resection of 2nd till 4th Rib cartilages with careful preservation of the posterior perichondrium. In selected rigid cases addition limited resection or transection of 5-7 cartilages at the sternal end. Perichondrium is separated from cartilage easily in adolescents and young adults. With age it fuses to cartilage and sometimes it is difficult to find correct layer. Surgeon should keep in mind that complete removal of cartilage with perichondrium may result in irreversible chest wall weakness. In such situation we prefer partial cartilage removal and suturing it at the end of procedure;
- V-shape horizontal partial sternal resection at the top of deformity with preservation of posterior cortex. Can be done both by Lobster and Chisel [as shown in the video (Figure 3)] or by power saw;
- Remodeling of sternum by downward pressure at the top of deformity and upward pulling of sternal body. This maneuver causes breakage (if sternum is rigid) or bending of posterior cortex but without disruption of posterior periosteum;
- Sternal osteosynthesis by parallel vertical low profile titanium plates (DePuy-Synthes, Switzerland). It is preferable to make bicortical fixation. Vertical parallel position of plates allows future possibility of midline sternotomy;
- Submuscular drainage, approximation of pectorals and wound closure.
Video (Figure 3) shows steps of surgical correction of pectus arcuatum in male (vertical midline incision) with 2-level osteotomy and female (submammarian incision) with 1-level osteotomy.
Early activation, usually next day walking under control, epidural catheter removed day 3–4, drains removed day 5 (if less than 50 cc drained), discharged from the hospital day 6. No contact sports for 6 months.
In this video we show our modification of pectus arcuatum correction with only partial sternal osteotomy and further stabilization by vertical parallel titanium plates.
Several methods of surgical correction are described previously (3-5) sternal osteotomy being and essential part of correction. Method presented here is completely extrapleural, without retrosternal support and with no need of second surgery for hardware removal.
We gratefully acknowledge Marianna Iskra BSc for video editing and graphic work.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The study was approved by the institutional ethical committee. Written informed consent was obtained from the patient for publication. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Currarino G, Silverman FN. Premature obliteration of the sternal sutures and pigeon-breast deformity. Radiology 1958; 70: 532-40. [Crossref] [PubMed]
- Kuzmichev V, Ershova K, Adamyan R. Surgical correction of pectus arcuatum. Asvide 2016; 3: 166. Available online: http://www.asvide.com/articles/914
- Ravitch MM. Operative Correction of Pectus Carinatum (Pigeon Breast). Ann Surg. 1960; 151: 705-14. [Crossref] [PubMed]
- Robicsek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg 2009; 21: 64-75. [Crossref] [PubMed]
- Brichon PY, Wihlm JM. Correction of a severe pouter pigeon breast by triple sternal osteotomy with a novel titanium rib bridge fixation. Ann Thorac Surg 2010; 90: e97-9. [Crossref] [PubMed]
Cite this article as: Kuzmichev V, Ershova K, Adamyan R. Surgical correction of pectus arcuatum. J Vis Surg 2016; 2:55.
- How to use jojoba crystal wax
- Top side of beef 1 kg how many grams
- How to change href color css hex
- How to give a hanging wedgie
- How do I write a resignation email example
- What's more donate key apk Android
- How to pass the acrp cra exam
- How to add pictures to Skype chat
- Wow inscription how to learn more glyphs
- Friends group icon pictures for WhatsApp angels
- What does shabby mean in slang
- Accident in Howsham Lincs' vocabulary
- Batik saris wholesale in Surat
- How do you stay on the same level
- How to draw the skeleton king Minecraft
- Switch subsonic filter on or off when shocking
- How to dress like Chapin Wright
- When are doterra lrp points awarded?
- What does HPV scam mean
- Work Hard Anywhere Sticker Bomb
- What is an ICAP server
- Adrian Pang Tracie Howitt parents
- Always howland interview outfits
- When god made you natalie, give me