Development of a bioabsorbable weave technique for repair of pectus deformities


Purpose: Despite the often striking improvement in symptoms, objective proof of a physiologic response to repair of pectus deformities has been difficult to document. However, cosmetic correction of these deformities with resultant improvement in self-image and psychological parameters has become an accepted indication for repair. Several methods of repair have achieved good results in terms of cosmesis and long-term stability, and include the following principles: resection of all involved cartilages, osteotomy of the sternum to correct the deformity, and some form of posterior support to maintain the sternum in a fixed position while healing occurs. Over the preceding four years we have developed a technique of pectus excavatum repair incorporating these principles.

Methods: Standard incisions are used with mobilization of both pectoralis muscles from the involved costochondral junctions. Subperichondrial resections of all involved cartilages are performed, however, the inercostal muscles and perichondium are not detached from the sternum. An anterior osteotomy is made. Horizontal mattress sutures of #1 PDS are then used to support the sternum posteriorly.

Results: During the past four years, fourteen patients at Wilford Hall Medical Center have undergone repair of pectus deformities; twelve were for pectus excavatum and two were for pectus carinatum. The majority of patients were male and the median age was 15 years. Of the patients undergoing pectus excavatum repairs, four had posterior support with a metal bar (Adkin's bar), one with autologous rib, and seven with some variation of the technique described herein. Neither patient with pectus carinatum required posterior support. Three of the four patients with Adkin's bar support required later operation for removal. All patients but one have experienced satisfactory to excellent results without recurrence of the chest wall deformities.

Conclusions: The technique we have developed avoids the problems with metal bar support such as the need for reoperation, as well as potentially disastrous complications such as perforation of mediastinal, pleural or arterial structures. Posterior support is supplied during the healing phase and the entire blood supply of the sternum and costochondral beds is preserved. Clinical Implications: A technique is described for repair of pectus deformities of the chest which avoids the problems associated with nonabsorbable structural support. Eary results have been excellent.

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