[Surgical treatment of thoracic wall malformations].
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Abstract:
Anterior chest wall deformities in children are the expression of some congenital malformation such as Poland's syndrome and pectus excavatum. The surgical treatment of these malformations affecting children is aimed at correcting large wall defects and stabilizing the chest wall, assuring at the same time chest harmonious growth and postoperative functional assessment. We present the results of the treatment of 2 cases of Poland's syndrome, 20 cases of pectus excavatum and 2 cases of pectus carinatum, with a follow-up of 6 months--9 years.Keywords:
Pectus carinatum
Thoracic wall
Funnel Chest
Congenital malformations
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Pectus carinatum
Funnel Chest
Sternum
Thoracic wall
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Management of chest wall deformities has undergone extensive change in recent years. In some patients, treatment with non-surgical methods is possible both for pectus excavatum and pectus carinatum. Choosing the correct approach for each patient becomes a central question for the surgeon. Pectus excavatum is the most common chest wall deformity in infants, children, and adolescents. About two-thirds of children with pectus excavatum present with symptoms of shortness of breath during exercise and rapid development of fatigue. Scoliosis occurs in conjunction with pectus carinatum in 15% of children, which implies a diffuse abnormality in connective tissue development. The minimally invasive operation developed by Abramson is most successful in patients with a flexible chest. Poland's syndrome is a constellation of anomalies including absence of the pectoralis minor muscle, absence of the costal portion of the pectoralis major muscle, hypoplasia of the breast and nipple or complete absence of the breast and nipple, and brachysyndactyly of the digits.
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Etiology
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Pectus carinatum
Funnel Chest
Sternum
Thoracic wall
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Anterior chest wall deformities in children are the expression of some congenital malformation such as Poland's syndrome and pectus excavatum. The surgical treatment of these malformations affecting children is aimed at correcting large wall defects and stabilizing the chest wall, assuring at the same time chest harmonious growth and postoperative functional assessment. We present the results of the treatment of 2 cases of Poland's syndrome, 20 cases of pectus excavatum and 2 cases of pectus carinatum, with a follow-up of 6 months--9 years.
Pectus carinatum
Thoracic wall
Funnel Chest
Congenital malformations
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This review article covers the spectrum of congenital thoracic wall deformities along with their historical background. Willital's classification divides these deformities into 11 types - funnel chest (4 types), pigeon chest (4 types), and combination of funnel and pigeon chest, chest wall aplasia and cleft sternum. Records of patients at our center comprised 90% depression deformities, 6% protrusion deformities, 3% combined depression-protrusion deformities and 1% other forms. Mild forms of abnormalities warrant the wait- and-watch approach during the first 4-5 years. The deformities manifest primarily during the pubertal spurt often with rapid progression with subjective complaints like dyspnea, cardiac dysthesia, limited work performance and secondary changes. Operative correction in young adults is more favorable in mild cases. The Willital technique has been the standard technique for the correction of pectus excavatum, pectus carinatum and other combined forms of deformities at our center with excellent long term results. The Nuss procedure and the Pectus Less Invasive Extrapleural Repair (PLIER) technique for pectus excavatum and pectus carinatum have also been described in this article. Surgical correction for Poland’s syndrome is reserved for patients with severe aplasia of the ribs with major depression deformity. Sternal defects including various types of ectopia cordis are discussed. Even after surgical correction, there is significant reduction in the total capacity and inspiratory vital capacity of the lungs, probably a result of the decreased compliance of the chest wall. However, the efficiency of breathing at maximal exercise improves significantly after operation.
Pectus carinatum
Funnel Chest
Sternum
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Pectus carinatum
Funnel Chest
Honor
Sternum
Cardiothoracic surgery
Poland syndrome
Thoracic wall
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Background : The results of correxion surgery of the chest wall deformities are pretty good. The aims of surgery are provide cosmetic improvement and eliminate the negative side-effects of on the cardiopulmonary system. We presented our clinic experince in patients who were operated with pectus deformities. Methods: Between 2003 - 2011, total of 41 patients who underwent modified Rawitch technique with pectus excavatum and pectus carinatum were included in this study. Kirschner wire was used for sternal fixation. Kirshner wire was taken between postoperative 12 - 15 days. Results : No mortality was observed. Recurrence occured in one patient (2.4%). Operative time lasted between 2.2 - 3.2 hours (mean 1.8 hours). Age, ranged between 4 - 26 years, mean age was 14.3 years. Thirteen of patients were pectus carinatum, and 25 of them were pectus excavatum. Three patients had mixed type deformity. There were no major complications. The morbidity rate was 26.8%. Mean hospital stay was 18.3 days (17 - 28 days). Conclusions : Cosmetic and psychological problems in patients with pectus deformities improved with surgical correction. In addition, this operation eliminates the negative effects of cardiopulmonary system. The stabilization of sternum with Kirschner wire is a cheap, effective and uncomplicated. doi:10.4021/jcs46w
Pectus carinatum
Kirschner wire
Sternum
Funnel Chest
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Pectus carinatum
Sternum
Poland syndrome
Funnel Chest
Thorax (insect anatomy)
Thoracic wall
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Thoracic wall
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