Surgical Experience with Reconstruction of Chest Wall Deformities

Abstract

Aim: To analyze the clinical data, the indications and results for the surgical reconstruction of the chest wall deformities.
Methods: With the purpose of assessing the information, clinical data of 45 patients treated with surgical procedures for Pectus Excavatum (PE) and Pectus Carinatutm (PC) in the Thoracic Surgery Department of the Hospital Calderón Guardia during the period of January 1998 to January 2010, was analyzed.
Results: During this period 29 patients were surgically treated for PE and 16 for Pectus Carinatum, 37 male and 8 female. Ages started from 13 to 24 with a median of 16 years. In 28 patients the surgical indication was the emotional stress caused by the deformity, 17 had in addition to that, symptoms like dyspnea during exercise, chest pain or palpitations. In 26 of the 29 patients operated for PE a metal bar was utilized to hold the sternum in position and removed 6 months later and in the last 3 patients a polypropylene mesh was used with the same function with no need of reintervention to remove it. The results were subjectively evaluated according to the patient's satisfaction and the medical notes. In one patient with PE the deformity recurred but not the symptoms. In forty four patients the symptoms disappeared and there was a cosmetic satisfaction but 3 developed hypertrophic scars. One patient, five months after the surgery, had a dislodged sternal bar and hemothorax needing a chest tube for evacuation and removal of the bar. Ten patients had a chest tube for opening of the pleura during the surgical procedure. There were not deaths and no other complications were documented.
Conclusion: Surgery for correction of the PE and PC deformities with physiologic alterations and cosmetic patient suffering could be performed with low morbidity and good cosmetic results, except for the patients who develop hypertrophic scars. A polypropylene mesh substitutes the metal bar and does not need a reitervention to be removed.