scholarly journals Is vacuum bell therapy effective in the correction of pectus excavatum?

2019 ◽  
Vol 29 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Akshay J Patel ◽  
Ian Hunt
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
Significant Heterogeneity ◽  
Nuss Procedure ◽  
Soft Tissue Dissection ◽  
Computed Tomography Scanning ◽  
Wall Flexibility ◽  
Clinical Questions ◽  
Study Type

Abstract A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: ‘In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?’ Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.

scholarly journals Nuss Procedure for a Patient with Negative Haller Index

2018 ◽  
Vol 06 (01) ◽  
pp. e18-e22 ◽  
Author(s):  
Mariela Dore ◽  
Paloma Triana Junco ◽  
Carlos De La Torre ◽  
Alejandra Vilanova-Sánchez ◽  
Monserrat Bret ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Vena Cava ◽  
Forced Expiratory Volume ◽  
Exercise Intolerance ◽  
Nuss Procedure ◽  
Invasive Approach ◽  
History Of ◽  
Ventilation Pattern

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed.All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

scholarly journals Extra-thoracal migration of the Nuss Bar in corrective surgery for pectus excavatum: a very rare late complication

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Natalie Simon ◽  
Shyam Kolvekar ◽  
Amir Khosravi
Keyword(s):  
Pectus Excavatum ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Late Complication ◽  
Nuss Procedure ◽  
Corrective Surgery ◽  
Chest Wall Deformity ◽  
X Ray ◽  
First Case

Abstract Pectus excavatum is a chest wall deformity with an incidence of around 1 in 400 live births. The Nuss procedure is a surgical intervention that aims to restore functional integrity in these patients. We report the first case of bar migration into the stomach necessitating further surgical intervention for removal. Our case presents a rare complication of pectus excavatum repair and highlights the importance of vigilant follow-up in these patients. If bar migration does occur, imaging in the form of X-ray and CT scans may be of use in early detection in order to expedite management.

Effects of the Nuss procedure on chest wall kinematics in adolescents with pectus excavatum

2012 ◽  
Vol 183 (2) ◽  
pp. 122-127 ◽  
Author(s):  
B. Binazzi ◽  
G. Innocenti Bruni ◽  
F. Gigliotti ◽  
C. Coli ◽  
I. Romagnoli ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
Nuss Procedure ◽  
Chest Wall Kinematics

scholarly journals Radiological changes after Nuss operation for pectus excavatum

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 699 ◽  
Author(s):  
Artūras Kilda ◽  
Saulius Lukoševičius ◽  
Vidmantas Barauskas ◽  
Živilė Jankauskaitė ◽  
Algidas Basevičius
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
First Year ◽  
Nuss Procedure ◽  
Funnel Chest ◽  
Haller Index ◽  
Wall Deformation ◽  
Lateral Chest ◽  
Radiological Changes ◽  
The Mean

The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. Materials and methods. Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. Results. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012). Conclusions. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.

scholarly journals Three-Dimensional Simulation for Breast Augmentation of Female Asymmetric Pectus Excavatum: A Case Report

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Yoshichika Yasunaga ◽  
Aya Tsuchiya ◽  
Yuta Nakajima ◽  
Shoji Kondoh ◽  
Masahiko Noguchi ◽  
...  
Keyword(s):  
Chest Wall ◽  
Breast Augmentation ◽  
Pectus Excavatum ◽  
Three Dimensional ◽  
Anterior Chest Wall ◽  
Nuss Procedure ◽  
Breast Asymmetry ◽  
Level Of Evidence ◽  
Dimensional Simulation ◽  
The Right

Abstract Breast augmentation for women with asymmetric pectus excavatum (PE) has a characteristic problem in that surgeons need to select implants while considering the left-right difference in breast volume, contour, and position. We herein report a 33-year-old woman with severe asymmetric PE who presented with residual breast asymmetry after chest wall correction using the Nuss procedure. Her right breast appeared hypoplastic and the right anterior chest wall remained depressed. Augmentation of the right breast with a silicone implant was performed, selecting the inserted implant preoperatively with the assistance of three-dimensional (3D) simulation. The breast asymmetry and anterior chest wall depression were improved to a natural appearance. Three-dimensional simulation represents an advantageous way to preoperatively select optimal implants for breast augmentation in asymmetric PE women with breast asymmetry. Level of Evidence: 5

scholarly journals Computer-Aided Design and Manufacturing Technology for Identification of Optimal Nuss Procedure and Fabrication of Patient-Specific Nuss Bar for Minimally Invasive Surgery of Pectus Excavatum

2018 ◽  
Vol 9 (1) ◽  
pp. 42 ◽  
Author(s):  
Yoon-Jin Kim ◽  
Jin-Young Heo ◽  
Ki-Hyun Hong ◽  
Hoseok I ◽  
Beop-Yong Lim ◽  
...  
Keyword(s):  
Chest Wall ◽  
Computer Aided Design ◽  
Pectus Excavatum ◽  
Optimal Operation ◽  
Numerical Control ◽  
Patient Specific ◽  
Nuss Procedure ◽  
Computer Aided ◽  
Aided Design ◽  
Design Drawing

The Nuss procedure is one of the most widely used operation techniques for pectus excavatum (PE) patients. It attains the normal shape of the chest wall by lifting the patient’s chest wall with the Nuss bar. However, the Nuss bar is for the most part bent by a hand bender according to the patient’s chest wall, and this procedure causes various problems such as the failure of the operation and a decreased satisfaction of the surgeon and patient about the operation. To solve this problem, we proposed a method for deriving the optimal operation result by designing patient-specific Nuss bars through computer-aided design (CAD) and computer-aided manufacturing (CAM), and by performing auto bending based on the design. In other words, a three-dimensional chest wall model was generated using the computed tomography (CT) image of a pectus excavatum patient, and an operation scenario was selected considering the Nuss bar insertion point and the post-operative chest wall shape. Then, a design drawing of the Nuss bar that could produce the optimal operation result was derived from the operation scenario. Furthermore, after a computerized numerical control (CNC) bending machine for the Nuss bar bending was constructed, the Nuss bar prototype was manufactured based on the derived design drawing of the Nuss bar. The Nuss bar designed and manufactured with the proposed method has been found to improve the Haller index (HI) of the pectus excavatum patient by approximately 37% (3.14 before to 1.98 after operation). Moreover, the machining error in the manufacturing was within ±5% compared to the design drawing. The method proposed and verified in this study is expected to reduce the failure rate of the Nuss procedure and significantly improve the satisfaction of the surgeon and patient about the operation.

Analysis of changes to the anterior chest wall after the Nuss procedure—an objective measurement of pectus excavatum

2009 ◽  
Vol 44 (12) ◽  
pp. 2291-2295 ◽  
Author(s):  
Pei-Yeh Chang ◽  
Chaur-Hsiang Chang ◽  
Jin-Yao Lai ◽  
Jeng-Chang Chen ◽  
Der-Baau Perng ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
Anterior Chest Wall ◽  
Objective Measurement ◽  
Nuss Procedure

scholarly journals Application of Polydioxanone Sutures in the Nuss Procedure

2021 ◽  
Author(s):  
Yimin Xie ◽  
Jinbo Ning
Keyword(s):  
Surgical Repair ◽  
Steel Wire ◽  
The Other ◽  
Risk Indicators ◽  
Nuss Procedure ◽  
Level Of Evidence ◽  
Wire Breakage ◽  
Steel Wires ◽  
Duration Of Operation

Abstract Background/Purpose The Nuss procedure is the most common surgical repair for pectus excavatum (PE). Surgical steel wires are used in some modifications of the Nuss procedure to attach one or both ends of a support bar to the ribs. During follow-up, wire breakage was found in some cases. Patients with wire breakage may undergo prolonged bar removal surgery and may be exposed to excessive radiation.In this study, we had a series of patients who received polydioxanone suture (PDS) fixations instead of steel wires. This retrospective study was conducted to explore the differences between these two fixation materials in the incidence of related complications and efficacies. Furthermore, we attempted to observe whether the two materials lead to similar surgical efficacy in the Nuss procedure, whether they have divergent effects on the bar removal surgery, and whether PDS can reduce the risks due to steel wire breakage as expected. Methods We retrospectively studied PDS and surgical steel wires as fixation materials for the Nuss procedure in children with congenital PE and reviewed the outcomes and complications. A total of 75 children who had undergone Nuss procedure repairs and bar removals from January 2013 to December 2019 were recruited to participate in this study. They were divided into three groups: the PDS group, the unbroken wire (UBW) group, and the broken wire (BW) group, according to the fixation materials and whether the wires had broken or not. Moreover, we selected the duration of operation (DO), intraoperative blood loss (BL), bar displacement (BD), postoperative pain score (PPS), and incision infection as the risk indicators and the postrepair Haller index (HI) as the effectiveness indicator. These indicators were statistically compared to determine whether there were differences among the three groups. Results One BD occurred in the PDS and BW groups while none took place in the UBW group. No incision infection was found in any of the groups. The PDS group had the shortest DO, while the DO in the UBW group was shorter than that in the BW group (p < 0.05). BL in the PDS group was less than that in the other two groups (p < 0.05). Additionally, no difference was observed in BL between the BW and UBW groups (p > 0.05). The PPS of the PDS group was less than that of the BW group (p < 0.05), whereas no differences were found between the other two groups. No statistical difference emerged in HI among the groups (p > 0.05). Conclusion PDS fixation results in a similar repair outcome and shows certain advantages in the DO, BL, and PPS; also, PDSs are safe and effective in the Nuss procedure. Level of evidence Level III.

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