Single Stage Surgical Correction of Pectus Excavatum with Significant Lower Costal Flaring

Jose R. Matilla, György Lang, Thomas Klikovits, Thomas Schweiger, Stefan Schwarz, Alberto Benazzo, Walter Klepetko

Thoracic Surgery. Vienna University Hospital, Vienna, Austria

Date, time and location: 2018.05.25 10:30, Press Hall, 2F

Abstract

Objectives: Since January 2013, 23 adult patients between 18 and 46 years old underwent surgical correction for pectus excavatum associated with lower asymmetrical costal flaring. Two of these patients had already one surgical attempt to correct the deformity. The use of this single stage technique as first therapeutic option in this kind of pathology was the aim of the study. Surgical steps will be described.

Methods: All patients had bilateral asymmetric costal flaring added to the pectus deformity. Open surgical approach with clamshell skin incision was performed. For pectus correction v-shape sternal osteotomy and Nuss bars (one or two) were employed. Cartilage limited resections with superficial rib osteotomies and posterior cartilage fixations were added to the procedure after Nuss bar placement, for accurate correction of the costal flaring. Analgesia pump was used to achieve adequate pain control.

Results: Satisfying cosmetic results were achieved in all patients after single stage procedure. Typical costal flaring worsening at minimal invasive Nuss procedures was avoided. Three patients suffered small medial wound dehiscence and were treated with continuous negative pressure therapy for two weeks before re-closure of the wound.

Conclusion: Single stage technique achieves complete deformity correction in this group of adult patients with low postoperative pain. Accurate time for bar(s) removal should be carefully calculated. Definition of reference centers would help to increase experience in such demanding cases.