Application of Polydioxanone Sutures in the Nuss Procedure

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.

Fig. 1

( A, B ) Posterior–anterior and right-lateral X-ray films with wire fixation 30 months after MIRPE in BW group. ( C, D ) Posterior–anterior and left-lateral X-ray films with wire fixation 34 months after MIRPE in UBW group. BW, broken wire; MIRPE, minimally invasive repair of pectus excavatum; UBW, unbroken wire.

Fig. 2

( A, B ) Posterior–anterior and right-lateral X-ray films with PDS fixation 36 months after MIRPE. ( C, D ) Posterior–anterior and right-lateral X-ray films with PDS fixation 6 months after bar removal. ( E ) Fixing the stabilizer with circumcostal PDS fixation. ( F ) Cutting the soft tissue in the hole of stabilizer with a small needle-knife; no wire needs to be removed. ( G ) Postoperative frontal view 6 months after MIRPE. ( H ) Postoperative frontal view 6 months after bar removal. MIRPE, minimally invasive repair of pectus excavatum; PDS, polydioxanone suture.