1/11. A new method of reconstruction for pectus excavatum that preserves blood supply and costal cartilage.We began in 1982 to use a modified Ravitch procedure that preserves the blood supply to the sternum to correct funnel chest deformities, but there were some problems such as postoperative paradoxical respiration, chest wall irregularity, and palpable heart beat. To resolve these problems, the concept of Jensen's procedure was incorporated into the authors' previous method. In Jensen's method, only a small portion of the deformed cartilages is resected, and almost all of them are preserved. A preformed stainless steel strut is used for chest wall stabilization. The authors preserved the costal cartilages in a manner similar to Jensen's, but the anterior chest wall was stabilized with miniplates and Kirschner wires instead of a large retrosternal strut. The xiphoid process with the lower end of the sternum was detached and moved cephalad. None of the patients developed respiratory failure postoperatively. Although the follow-up periods were short, satisfactory results were obtained with no recurrence of the deformities. The main advantages of our procedure are (1) basic blood supply to the chest wall is preserved, (2) stability of corrected chest wall is maintained with miniplates and Kirschner wires without a large metallic strut, and (3) preserved costal cartilages make the chest wall rigid and the incidence of respiratory failure low. We conclude that this method is simple and produces satisfactory results with a rigid chest wall.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
2/11. Removal of migrating pectus bars by video-assisted thoracoscopy.Surgical correction of pectus excavatum deformity with the use of a metal bar strut provides a good cosmetic result with a low complication rate. Reports of pectus bar migration are rare but we report three cases of bar migration which required thoracoscopic removal.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
3/11. New material for Nuss procedure.The Nuss procedure for pectus excavatum repair has been considered an acceptable method in terms of its decreased invasiveness and excellent cosmetic results. Although a steel bar is usually used for elevating the sternum, we used a titanium alloy plate for pectus excavatum repair for the first time. The characteristics of this plate are that 1) it comes out translucently on x-rays, 2) MRI examination is possible because titanium will not be magnetized, and 3) it is possible to go through the security checkpoint at the airport without setting off the metal detector. Furthermore, the titanium alloy is highly elastic, which reduces complications such as dislocation, and it excels in the conformity to organization. patients who have received the Nuss operation are forced to somewhat limit their daily life for two or three years until the bar is removed. A plate made from titanium alloy resolves this problem because of its material and it is thought to be an ideal candidate for elevating the sternum during the Nuss operation.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
4/11. Should an infected Nuss bar be removed?BACKGROUND: The Nuss procedure is a minimally invasive procedure for correction of pectus excavatum. It involves insertion of a substernal metal bar. A feared complication of any implanted device is infection, which often necessitates removal. The purpose of this report is to describe the authors' experience with infectious complications after the Nuss procedure. methods: From February 2000 to July 2002, 102 patients underwent the Nuss procedure in 2 pediatric surgical centers. In a retrospective way, the files of those patients in whom a postoperative infection developed were studied. RESULTS: Seven patients suffered postoperative infectious complications. Only one bar needed to be removed. CONCLUSION: The authors' experience indicates that there is no need for immediate removal of an infected Nuss bar. Most of these infections can be managed conservatively. However, early antibiotic treatment is warranted to ensure salvage of the bar.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
5/11. coronary artery bypass via resternotomy after pectus excavatum repair.Pectus excavatum is a chest wall deformity that commonly warrants pediatric surgical correction for cosmesis or respiratory impairment via sternotomy. The repair typically consists of sternal wedge osteotomy and subsequent placement of a Steinman pin across the sternum with fixation to the ribs bilaterally. coronary artery bypass grafting (CABG) after surgical repair of the sternum with a metal implant poses an intriguing surgical challenge. literature review reveals only one such previously described case. We present a case of coronary revascularization in an adult who previously underwent pectus excavatum repair with ligation of the internal mammary arteries. Our coronary revascularization was accessed through a resternotomy after surgical removal of the metal implant previously placed during the pectus excavatum repair. Autologous greater saphenous vein was used as a conduit for bypass. The patient did well postoperatively and was discharged on postoperative day 4. The pectus repair remained intact even after the median sternotomy was performed. This was confirmed at the 1-year follow-up for the patient. Resternotomy after pectus excavatum repair with a prosthetic implant poses a challenge to cardiothoracic surgeons. Many such repairs have been described in the pediatric population. As our society ages and coronary artery disease becomes more prevalent, this unique situation may be more commonly encountered. We present an approach to coronary artery bypass grafting via median resternotomy after pectus excavatum repair.- - - - - - - - - - ranking = 2keywords = metal (Clic here for more details about this article) |
6/11. Complications of the minimally invasive repair of pectus excavatum.BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) has become widely popular since its introduction in the late 1990s by Nuss. We describe 1 unusual complication after MIRPE and 1 life-threatening bleeding during removal of the pectus bar. methods: We report the cases of 2 patients in a single institution, more than 100 MIRPE procedures performed so far, and review of literature. CASES: A 14-year-old girl presented 6 months after MIRPE in another institution. During removal of the pectus bar, a massive hemorrhage from both chest wounds occurred, requiring emergency sternotomy. Arrosion of a pulmonary vessel close to the metal bar had led to the bleeding. The second case was a bilateral sternoclavicular dislocation after MIRPE, which has not caused symptoms so far, in a 13-year-old girl. CONCLUSIONS: Numerous operative and postoperative complications after MIRPE are feasible. This is the first report of a life-threatening bleeding during removal of the pectus bar. Minimally invasive repair of pectus excavatum procedure and removal of the pectus bar should only occur in specialized institutions with wide experience in thoracic surgery.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
7/11. cardiopulmonary resuscitation in patients with a Nuss bar--a case report and review of the literature.Pectus excavatum (PE) is a common chest wall deformity that may produce a variety of physiological and psychological effects in children and adolescents. In addition, some of these patients have associated cardiac diseases (ie, mitral valve prolapse and marfan syndrome). Recently, a minimally invasive surgical repair of PE that requires sternal bar placement has become increasingly frequent to enhance patients' cardiopulmonary functioning as well as their self-esteem. However, despite this innovative technique, it is possible for such patients to have a cardiac arrest while their sternal bar is in place. Whether the presence of a metal bar on the underside of their sternum may hinder resuscitative chest compressions (cardiopulmonary resuscitation) is an issue that concerns us, our patients, and their families; the answer requires further investigation. We present a 21-year-old man with PE who underwent a minimally invasive pectus repair but had a fatal cardiac event before bar removal. Paramedics conducting cardiopulmonary resuscitation on the patient later reported that they were unable to deliver effective cardiac compressions and that the sternal bar may have contributed to this.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
8/11. Vascularized rib strut technique for repair of pectus excavatum.A vascularized rib strut based on the anterior intercostal branch of the internal mammary artery was applied to provide rigid internal fixation of the chest wall after correction of pectus excavatum. The procedure is simple and has substantial advantages when compared with techniques using metallic struts or nonvascularized free rib grafts.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
9/11. Hemopericardium: a late complication after repair of pectus excavatum.Hemopericardium and tamponade occurred in a 12 year old boy with Marfan's syndrome, two years after surgical repair of pectus excavatum. This life-threatening complication resulted from penetration of a fractured metal plate through the pericardium into the right atrium. The clinical details are reported and discussed.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
10/11. Laceration of the phrenic artery. A life-threatening complication after repair of pectus excavatum.We report a case of life-threatening hemothorax three months after surgical repair of pectus excavatum. angiography revealed the hemorrhage to originate from a laceration of the phrenic artery secondary to dislodgment of the metal strut used for the repair. awareness of this rare complication in patients after repair of pectus excavatum is required.- - - - - - - - - - ranking = 1keywords = metal (Clic here for more details about this article) |
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