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. 2016 Mar 23:2:64.
doi: 10.21037/jovs.2016.03.11. eCollection 2016.

Minimally invasive repair of pectus carinatum and how to deal with complications

Horacio Abramson  1 , Xavier Aragone  1 , Javier Borbore Blanco  1 , Alejandro Ciano  1 , Leonardo Abramson  2
Affiliations

Minimally invasive repair of pectus carinatum and how to deal with complications

Horacio Abramson et al. J Vis Surg. .

Abstract

While less common than pectus excavatum, pectus carinatum is also a chest wall deformity affecting males in higher proportion than women. Patient requests for a solution of this disease occur especially during the growth spurt of puberty when this malformation becomes more obvious and difficult to conceal. Those people suffering from pectus carinatum are very likely subject to behavioral changes and negative personality impacts. By compressing the protruding anterior region of the chest wall we achieve correction of the chest contour and simultaneous lateral expansion of the depressed costochondral arches. This original technique and the procedure to apply it fit within the category of minimally invasive surgery. The compression system acts in a way similar to that of orthodontic braces. Two rectangular fixation plates are fixed to the compression strut with screws. The plates have threaded holes along a groove in the central portion, and two holes at both ends used to attach them to the ribs by means of steel wire suture. The compression strut has to be modified into a convex shape to adapt it to the particular characteristics of the patient's malformation. This molding is done using benders designed as part of the procedure.

Keywords: Pectus carinatum; minimal access; minimally invasive surgery; thorax abnormalities.

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Conflict of interest statement

Conflicts of Interest: Dr. Horacio Abramson is owner of an USA patent: “Apparatus for the correction of chest wall deformities such as pectus carinatum and method of using the same”.

Figures

Figure 1
Figure 1
Instrumental tools (9). Available online: http://www.asvide.com/articles/870
Figure 2
Figure 2
Tools item. [1] Bone cutting forcep; [2] trocar; [3] pericostal wire; [4] template; [5] hook; [6] manual bender; [7] in situ benders; [8] screw drivers; [9] plier; [10] retractors; [11] pericostal tools; [12] rib raspatories; [13] PVC tube; [14] scissors; [15] screws; [16] fixation plate.
Figure 3
Figure 3
Pre-sternal bars.
Figure 4
Figure 4
Skin marking (10). Available online: http://www.asvide.com/articles/871
Figure 5
Figure 5
Patient.
Figure 6
Figure 6
Lateral view.
Figure 7
Figure 7
Skin marking.
Figure 8
Figure 8
Anesthetic blockage.
Figure 9
Figure 9
Submammary incision.
Figure 10
Figure 10
Perichondrial separation.
Figure 11
Figure 11
Costal curettage (11). Available online: http://www.asvide.com/articles/872
Figure 12
Figure 12
Pericostal passage.
Figure 13
Figure 13
Pericostal tube journey (12). Available online: http://www.asvide.com/articles/873
Figure 14
Figure 14
Pericostal wire journey (13). Available online: http://www.asvide.com/articles/874
Figure 15
Figure 15
Second pericostal wire journey (14). Available online: http://www.asvide.com/articles/875
Figure 16
Figure 16
Tip wire protection (15). Available online: http://www.asvide.com/articles/876
Figure 17
Figure 17
Tip wire protection (16). Available online: http://www.asvide.com/articles/877
Figure 18
Figure 18
Water check (17). Available online: http://www.asvide.com/articles/879
Figure 19
Figure 19
Sub-muscular pocket (18). Available online: http://www.asvide.com/articles/880
Figure 20
Figure 20
Sub-muscular pocket (19). Available online: http://www.asvide.com/articles/881
Figure 21
Figure 21
Fixation plate insertion (20). Available online: http://www.asvide.com/articles/882
Figure 22
Figure 22
Fixation plate insertion (21). Available online: http://www.asvide.com/articles/883
Figure 23
Figure 23
Fixation plate introduction.
Figure 24
Figure 24
Sub-muscular tunnel (22). Available online: http://www.asvide.com/articles/884
Figure 25
Figure 25
Trocar and tube insertion (23). Available online: http://www.asvide.com/articles/885
Figure 26
Figure 26
Trocar removal (24). Available online: http://www.asvide.com/articles/886
Figure 27
Figure 27
Sub-muscular tunnel opposite side (25). Available online: http://www.asvide.com/articles/887
Figure 28
Figure 28
Trocar insertion (26). Available online: http://www.asvide.com/articles/889
Figure 29
Figure 29
A longer tube passage (27). Available online: http://www.asvide.com/articles/890
Figure 30
Figure 30
Template bending (28). Available online: http://www.asvide.com/articles/891
Figure 31
Figure 31
Bar bending 1 (29). Available online: http://www.asvide.com/articles/892
Figure 32
Figure 32
Bar bending 2 (30). Available online: http://www.asvide.com/articles/893
Figure 33
Figure 33
Bar bending 3 (31). Available online: http://www.asvide.com/articles/894
Figure 34
Figure 34
Bar insertion (32). Available online: http://www.asvide.com/articles/895
Figure 35
Figure 35
Bar insertion (33). Available online: http://www.asvide.com/articles/896
Figure 36
Figure 36
Bar compression (34). Available online: http://www.asvide.com/articles/897
Figure 37
Figure 37
Final bar bending (35). Available online: http://www.asvide.com/articles/898
Figure 38
Figure 38
First screw insertion (36). Available online: http://www.asvide.com/articles/899
Figure 39
Figure 39
Final wire adjustment (37). Available online: http://www.asvide.com/articles/900
Figure 40
Figure 40
Final wire adjustment (38). Available online: http://www.asvide.com/articles/901
Figure 41
Figure 41
Screw adjusting (39). Available online: http://www.asvide.com/articles/902
Figure 42
Figure 42
Screws adjustment.
Figure 43
Figure 43
Result.
See this image and copyright information in PMC

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