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An Approach to the Management of Chest Wall Deformities

  • N. A. Myers
Part of the Progress in Pediatric Surgery book series (PEDIATRIC, volume 27)

Summary

Chest wall deformities are seen frequently in children and adolescents. Fortunately, the deformity is usually mild and the only therapeutic requirement is patient and family reasurance. If the deformity is more severe, consideration must be given to surgical correction. Although sophisticated studies have shown that cardiopulmonary function may be limited by funnel chest, the findings are rarely of clinical significance and, therefore, with few exceptions, operations will be performed for cosmetic and/or psychological reasons. In order to be able to manage patients with chest wall deformities appropriately, clarity of thinking is essential in relation to classification, symptomatology and treatment options. Before reaching a final decision regarding operation, several interviews may be required. In order to assess the final result, long-term follow-up is mandatory.

Keywords

Costal Cartilage Pectus Excavatum Chest Wall Deformity Chest Wall Defor Pectus Carinatum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Zusammenfassung

Brustwanddeformitäten sind häufig bei Kindern und Jugendlichen. Glücklicherweise sind die Deformitäten gewöhnlich nur wenig ausgeprägt, und die einzige therapeutische Maßnahme ist Beruhigung von Patienten und Familien. Wenn die Deformität schwerer ist, muß die chirurgische Korrektur ins Auge gefaßt werden. Obwohl ausgeklügelte Untersuchungen ergeben haben, daß die kardiopulmonale Funktion durch die Trichterbrust eingeschränkt sein kann, haben diese Befunde jedoch kaum klinische Bedeutung, und somit werden - mit einigen wenigen Ausnahmen- die Operationen aus kosmetischen und/oder psychologischen Gründen durchgeführt. Um Patienten mit Brustwanddeformitäten optimal betreuen zu können, ist eine Klarheit des Denkens in bezug auf Schweregrad, Symptomatik und therapeutische Ziele nötig. Bevor eine endgültige Entscheidung für eine Operation getroffen wird, sind manchmal wiederholte Gespräche erforderlich. Um das endgültige Resultat beurteilen zu können, ist ein Langzeit-Follow-Up zwingend notwendig.

Résumé

Les déformations du thorax se rencontrent fréquemment chez les enfants et les adolescents.Heureusement, la déformation est en général peu importante et le traitement consiste essentiellement à rassurer le patient et la familie. Si la déformation est grave, il faudra envisager une intervention chirurgicale de correction. Bien que des études poussées et compliquées aient démontré que la fonction cardio-pulmonaire peut être entravée par la présence d’un thorax en entonnoir, les résutalts ont rarement une portée clinique et les interventions sont le plus souvent pratiquées pour des raisons esthétiques ou psychologiques. Pour un traitement approprié des déformations du sternum, il faut faire le point avec précision sur la classification, la symptomatologie et les options thérapeutiques. Avant de prendre la décision finale d’une intervention, des consultations répétées peuvent s’imposer. Pour pouvoir juger des résultats, il est indispensable de suivre le patient à long terme.

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References

  1. 1.
    Adkins PC, Blades B (1961) A stainless steel strut for correction of pectus excavatum. Surg Gynecol Obstet 113: 111PubMedGoogle Scholar
  2. 2.
    Bay V, Farthmann E, Naegele U (1970) Unoperated funnel chest in middle and advanced age: evaluation of indications for operation. J Pediatr Surg 5: 606PubMedCrossRefGoogle Scholar
  3. 3.
    Beasley SW, Tibballs J (1987) Efficacy and safety of continuous morphine infusion for post operative analgaesia in the paediatric surgical ward. Aust NZ J Surg 57: 233CrossRefGoogle Scholar
  4. 4.
    Blickman JG, Rosen PR, Welch KJ, et al (1985) Pectus excavatum in children: pulmonary scintigraphy before and after corrective surgery. Radiology 167: 781Google Scholar
  5. 5.
    Brown AL (1939) Pectus excavatum (funnel chest) J Thorac Surg 9: 164Google Scholar
  6. 6.
    Cahill JL, Lees GM, Robertson HT (1984) A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. J Pediatr Surg 19: 430PubMedCrossRefGoogle Scholar
  7. 7.
    Cantrell JR, Haller JA, Ravitch MM (1958) A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium and heart. Surg Gynecol Obstet 107: 602PubMedGoogle Scholar
  8. 8.
    Castile RG, Staats BA, Westbrook PR (1982) Symptomatic pectus deformities of the chest. Am Rev Respir Dis 126: 564PubMedGoogle Scholar
  9. 9.
    Currarino G, Silverman FN (1958) Premature obliteration of the sternal sutures and pigeon-breast deformity. Radiology 70: 532PubMedGoogle Scholar
  10. 10.
    Dilworth NM (1988) Children in pain: an underprivileged group. Editorial. J Pediatr Surg 23: 103CrossRefGoogle Scholar
  11. 11.
    Dilworth NM, Mackellar A (1987) Pain relief for the pediatric surgical patient. J Pediatr Surg 22: 264PubMedCrossRefGoogle Scholar
  12. 12.
    Fonkalsrud EW, Follette D, Sarwat AK (1978) Pectus excavatum repair using autologous perichondrium for sternal support. Arch Surg 113: 1433PubMedCrossRefGoogle Scholar
  13. 13.
    Gattiken H, Buhlmann A (1966) Cardiopulmonary function and exercise tolerance in supine and sitting position in patients with pectus excavatum. Helv Med Acta 33: 122Google Scholar
  14. 14.
    Gyllensward A, Irnell L, Michaellsson M, et al (1975) Pectus excavatum. A clinical study with longterm postoperative follow-up. Acta Paediatr Scand [Suppl] 255: 1CrossRefGoogle Scholar
  15. 15.
    Haller JA Jr, Shermeta DW, Teas JJ (1978) Correction of pectus excavatum without prosthesis or splints. Objective measurement of severity and management of asymmetrical deformities. Ann Thorac Surg 26: 73PubMedCrossRefGoogle Scholar
  16. 16.
    Haller JA Jr, Colombani PM, Miller D, et al (1984) Early reconstruction of Poland’s syndrome using autologous rib grafts combined with a latissimus dorsi flap. J Pediatr Surg 19: 423PubMedCrossRefGoogle Scholar
  17. 17.
    Hester TR Jr, Bostwick J III. (1982) Poland’s syndrome correction with latissimus muscle transposition. Plast Reconstr Surg 69: 226PubMedCrossRefGoogle Scholar
  18. 18.
    Hippocrates (1849) Genuine works, Sydenham SocietyGoogle Scholar
  19. 19.
    Holcomb GW Jr (1977) Surgical correction of pectus excavatum. J Pediatr Surg 12: 295PubMedCrossRefGoogle Scholar
  20. 20.
    Howard R (1958) Pigeon chest (protrusion deformity of the sternum) Med J Aust 2: 664Google Scholar
  21. 21.
    Howard R (1959) Funnel chest: its effect on cardiac function. Arch Dis Child 34: 5PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Howard R (1978) Funnel chest: results and description of an improved operative technique. Med J Aust 2: 134PubMedGoogle Scholar
  23. 23.
    Humpreys GH II, Jaretzki A III (1974) Operative correction of pectus excavatum. J Pediatr Surg 9: 899CrossRefGoogle Scholar
  24. 24.
    Jamieson EB (1937) Illustrations of regional anatomy, sect 5. Livingstone, EdinburghGoogle Scholar
  25. 25.
    Jeune M, Carron R, Beraud C (1954) Polychondrodystrophie avec blocage thoracique d’evolution fatale. Pediatrie 9: 390PubMedGoogle Scholar
  26. 26.
    Jeune M, Carron R, Beraud C (1955) Dystrophie thoracique asphyxiante de caractere familial. Arch Franc Pediatr 12: 886Google Scholar
  27. 27.
    Koop CE (1956) The management of pectus excavatum. Surg Clin North Am 1627Google Scholar
  28. 28.
    Landtman B (1958) The heart in funnel chest. Pre and post operative studies of seventy cases. Ann Paediatr Fenn 4: 181PubMedGoogle Scholar
  29. 29.
    Lester CW (1946) The surgical treatment of funnel chest. Ann Surg 123: 1003CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Lyons HA, Zuhdi MN, Kelly JJ (1955) Pectus excavatum (“funnel breast”). A cause of impaired ventricular distensibility as established by right ventricular pressure patterns. Am Heart J 50: 921Google Scholar
  31. 31.
    Masson JK, Payne SW, Gonzalez JB (1970) Pectus excavatum: use of preformed prosthesis for correction in the adult. Plast Reconstr Surg 46: 399PubMedCrossRefGoogle Scholar
  32. 32.
    Mead J, Sly P, Le Soeuf P (1985) Rib cage mobility in pectus excavatum. Am Rev Respir Dis 132: 1223PubMedGoogle Scholar
  33. 33.
    Mogilner J, Siplovich L, Barziv J, et al (1988) Surgical management of the cleft sternum. J Pediatr Surg 23: 889PubMedCrossRefGoogle Scholar
  34. 34.
    Naef AP (1976) The surgical treatment of pectus excavatum: an experience with 90 operations. Ann Thorac Surg 21: 63PubMedCrossRefGoogle Scholar
  35. 35.
    Pickard LR, Tepas JJ, Shermeta DW, et al (1978) Pectus carinatum: results of surgical therapy. J Pediatr Surg 14: 228CrossRefGoogle Scholar
  36. 36.
    Poland A (1841) Deficiency of the pectoral muscles. Guy’s Hosp Rep VI: 191Google Scholar
  37. 37.
    Pouliquen JC, Beneux J, Pasteyer J, et al (1973) Turning over of the sternal breast plate as a treatment for funnel chest. Report of 19 cases. Ann Chir Inf 14: 245Google Scholar
  38. 38.
    Ravitch MM (1971) The form of congenital deformities of the chest and their treatment. Prog Pediatr Surg 3: 1–12PubMedGoogle Scholar
  39. 39.
    Ravitch MM (1973) Discussion of “surgical correction of pectus carinatum (pigeon breast).” Article by Welch KJ and Voss A. J Pediatr Surg 8: 666–667Google Scholar
  40. 40.
    Ravitch MM (1977) Congenital deformities of the chest wall and their operative correction. Saunders, PhiladelphiaGoogle Scholar
  41. 41.
    Rehbein F, Wernicke HH (1957) The operative treatment of the funnel chest. Arch Dis Child 32 (161): 5–8PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Rodgers BM, Webb CJ, Stergios D, et al (1988) Patient controlled analgaesia in pediatric surgery. J Pediatr Surg 23:259 43. Sbokos CG, McMillan IKR, Akins CW (1975) Surgical correction of pectus excavatum using a retrosternal bar. Thorax 30: 40Google Scholar
  43. 44.
    Shamberger RC, Welch KJ (1988) Surgical correction of chondromanubrial deformity ( Currarino Silverman Syndrome ). J Pediatr Surg 23: 319Google Scholar
  44. 45.
    Thomson J (1895) On a form of congenital thoracic deformity. Teratology 11:1-12, Plates I–VGoogle Scholar
  45. 46.
    Vecchione TR (1978) Cosmetic correction of the mild or partially corrected pectus excavatum utilizing silastic implant. Ann Plast Surg 1: 575PubMedCrossRefGoogle Scholar
  46. 47.
    Wada J, Ideka K (1972) Clinical experience with 306 funnel chest operations. Int Surg 57: 707PubMedGoogle Scholar
  47. 48.
    Welch KJ, Vos A (1973) Surgical correction of pectus cariantum. J Pediatr Surg 8: 659PubMedCrossRefGoogle Scholar
  48. 49.
    Wada J, Ikeda I, Ishida T, et al (1970) Results of 271 funnel chest operations. Ann Thorac Surg 10: 526PubMedCrossRefGoogle Scholar
  49. 50.
    Wesselhoeft CW Jr, De Luca FG (1982) A simplified approach to the repair of pediatric pectus deformities. Ann Thorac Surg 34: 640PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • N. A. Myers
    • 1
  1. 1.Royal Children’s Hospital MelbourneParkvilleAustralia

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