A novel surgical correction through a small transverse incision for pectus excavatum

Abstract

Surgical correction of pectus excavatum (PE) has been well established since Ravitch's publication in 1949. However, Ravitch's procedure, even if modified, was associated with the relatively radical nature of the operation. The aim of this study was to report our early experience and results in treatment of PE by a novel less invasive surgical technique through a small skin incision. From 1998 to 2003, a novel surgical correction through a small transverse incision was performed for 11 patients with PE, including 9 males and 2 females. The mean age was 9.2 years (range, 3 to 17 years). The less invasive surgical technique consisted of a small transverse skin incision over the deepest part of the PE deformity, subcutaneous dissection to the margin of the depressed deformity, elevation of pectoralis musculature from the midline toward the lateral border of the operative field, subperichondrial resection of the short segment (1 to 2 cm) of the involved costal cartilages, detachment of the xiphoid process and elevation of the sternum with sharp or blunt dissection, retrosternal titanium miniplate strutting, placement of drainage tubes in the mediastinum or pleural spaces, and closure of the operative wound. No sternal osteotomy was performed in this series. The average length of the skin incision was 3.2 cm. The number of the resected cartilages varied from 3 to 6 ribs on each side. The average blood loss was 41 mL (range, 10 to 80 mL), and the operation time was 3.1 hours. The duration of hospitalization was 4.4 days on average. There was no surgical complication or mortality. All patients were satisfied with their cosmesis, and no migration of the retrosternal strut was found in chest radiographs until the date of analysis. This less invasive surgical technique, which did not require osteotomy, could be effectively performed through a small skin incision and was associated with steady recovery of chest wall deformity, as well as excellent cosmetic results.