Surgical treatment of pectus excavatum

Pectus excavatum is very harmful to patients. If it is not treated, it will become more serious. Therefore, many patients with pectus excavatum want to learn more about the surgical treatment methods of pectus excavatum in order to undergo surgical treatment as soon as possible and recover as soon as possible. In order for you to have a comprehensive understanding, please read the detailed introduction below.

1. Rib plasty: For unilateral deep pectus excavatum that does not involve the sternum, rib plasty can be performed. The method is to make a curved incision from the midline to the affected side, dissect the deformed costal cartilage and ribs under the costal cartilage periosteum and rib periosteum, make multiple transverse incisions to correct the deformity, pull the costal cartilage upward to the sternum, sew the costal cartilage to the front of the sternum with sutures, then suture the bone, sew the costal cartilage to the front of the sternum with sutures, and then suture the skin. This operation is simple and suitable for milder cases of funnel chest.

2. Sternum lift surgery is to remove the deformed full-length costal cartilage (3rd to 6th costal cartilage) from under the costal cartilage periosteum to make the sternum completely free below the 2nd rib, and make an osteotomy at the upper end of the sternum at the level of the 2nd rib on the posterior plate of the sternum. The costal cartilage piece is clamped at the osteotomy site and sutured to fix it, thus lifting the sternum. Then cut the second costal cartilage obliquely from inside to outside, overlap the medial end of the costal cartilage on the lateral end of the costal cartilage and suture it, which is the three-point fixation method. Finally, suture the intercostal muscles and rectus abdominis muscles to the sternum respectively, and suture the skin. This method may cause abnormal breathing after surgery. Some people use metal pins or metal plates to strengthen fixation, which can avoid abnormal breathing after surgery and re-collapse of the sternum after surgery. The disadvantage of this method is that it requires another surgery to remove the fixed metal material, so it is not very popular.

3. Sternum and rib lift is particularly suitable for younger patients whose costal cartilage and rib bones are relatively flexible. After a midline incision of the skin, the sunken sternum and costal cartilage are exposed, the ribs are freed under the costal cartilage periosteum, the 3rd to 7th costal cartilages are cut close to the sternum, and the intercostal muscles are cut laterally to make the ribs and the front ends of the costal cartilages fully free. Multiple transverse wedge-shaped resections are made on the ventral surface of the costal cartilage to lift the costal cartilage upward and restore it to its normal position. The excessive costal cartilage is cut off, and the corresponding costal cartilage ends are sutured with polyester thread to increase the anterior-posterior diameter of the thorax to approach its normal shape. The combined force of the costal cartilages pulling upward on both sides lifts the sunken sternum upward, so it is called sternum and rib lift.

4. Sternum turnover with pedicles of upper and lower blood vessels: A median skin incision is made in the chest and abdomen to free the pectoralis major muscles on both sides to the outside, exposing the sunken sternum and the deformed ribs and costal cartilages on both sides. The rectus abdominis is freed along the outer edge of the rectus abdominis to the level of the umbilicus, and the lower edge of the costal arch is cut open. The sternum and the pleura on the inner surface of the costal cartilage on both sides are freed with fingers until the outside of the sunken deformity. The 7th to 3rd costal cartilages and intercostal muscles are cut off from the starting parts of both sides of the deformed costal cartilage. The internal thoracic arteries and veins on both sides are separated at the level of the 2nd intercostal space, and 4 to 5 cm are freed up and down. The sternum is transversely cut with a wire saw at this level to completely free the sunken sternum and the costal cartilages on both sides. The pectoralis muscle plate and costal cartilage with the internal thoracic arteries and veins and the rectus abdominis are then crossed. After flipping, the most concave part of the sternum becomes the most protruding part, and can be trimmed appropriately to make the sternum flat. Use stainless steel wire to suture the transverse ends of the sternum, and use polyester thread to suture each corresponding costal cartilage end and intercostal muscle. During suturing, remove the excessive costal cartilage so that the flipped sternal costal cartilage plate can be fixed in its original position very appropriately. After fixation, place a closed drainage tube behind the sternum, and then suture the pectoralis major muscle, subcutaneous tissue and skin.

During this operation, the internal thoracic artery and vein and the rectus abdominis muscle are not cut, so the blood circulation of the sternum can remain normal, ensuring the normal growth and development of the sternum after surgery. As long as the internal thoracic artery and vein are fully freed for 4 to 5 cm in length during the operation, there will generally be no difficulties during surgical reversal. Although the internal thoracic artery and vein and the rectus abdominis muscle are crossed in a cross shape, the arteries pulsate strongly and the veins will not be stagnant. After the operation, the chest wall was stable, there was no abnormal breathing, the patient could get up and move around as soon as possible, and the deformity correction effect was satisfactory. Some patients may experience mild localized depression in the transverse sternum of the upper chest 2 to 3 months after surgery. Some people advocate the use of a sternum traction frame to correct the above defect.

5. Sternum rotation with rectus abdominis pedicle This method is different from sternum rotation with superior and inferior vascular pedicles in that this method cuts off the internal thoracic artery and vein, leaving only the rectus abdominis pedicle as the source of blood supply. The surgical operation is basically the same as the previous method, except that the internal thoracic artery and vein are ligated and cut off first when the sternum is transected, and then the sternum is transected, the sternum and costal soft muscle plate are flipped 180° with the rectus abdominis pedicle, and the deformed sternum plate is trimmed and sutured to fix it in the original position.

6. Sessile pectoral muscle turnover surgery (Wada method) adopts the transverse incision in the middle of the sternum or bilateral submammary glands, frees the pectoralis major and rectus abdominis, exposes the deformed sternum, costal cartilage and ribs, and cuts the costal cartilage periosteum on both sides from the costal arch upward from the slightly bone side of the depressed part of the deformity, cuts the costal cartilage, and peels the costal cartilage and pectoral muscle from the periosteum, and cross-sections the sternum at the upper intercostal space where the sternum is depressed downward, and cuts off some intercostal muscles and soft tissues that may be attached. After flushing with antibiotic solution, the sternum plate flipped 180° is fixed to the sternal manubrium with steel wire, the excessive costal cartilage is cut off, and then it is sutured to the corresponding rib position with polyester thread, and the muscle and skin are sutured.

7. Sternum flip and overlap surgery. Some patients have a flat or sunken upper chest. During the operation, after the sternum plate is flipped, the front of the upper end of the sternum can be cut into an oblique shape, and the periosteum in front of the manubrium of the sternum can be inserted to overlap part of the pectoral muscles. The sternum plate is moved upward, and the overlapping sternum is sutured and fixed with steel wire. The costal cartilage is sutured with polyester thread, and some of the excessively long costal cartilage is also overlapped and sutured. In this way, the chest shape can be corrected more satisfactorily after the operation.

Sternum rotation surgery is more suitable for adult patients because adult sternum lift surgery is difficult to perform. No obstruction of sternal blood supply was found after pectoral muscle turnover surgery, causing the sternum to be destroyed or rejected by the body. The surgical effect was satisfactory.

The surgical treatment methods for pectus excavatum are introduced in detail above for many patients. Therefore, for many patients with pectus excavatum, do not miss some of the good treatment methods introduced above. Through comprehensive understanding, understand the surgical methods for treating pectus excavatum, and then through surgical treatment, recover as soon as possible and have a higher quality of life.