Towards a CAD-based automatic procedure for patient specific cutting guides to assist sternal osteotomies in pectus arcuatum surgical correction
Monica CarfagniFlavio FacchiniRocco FurferiMarco GhionzoliLapo GoverniAntonio MessineoFrancesca UcchedduYary Volpe
15
Citation
34
Reference
10
Related Paper
Citation Trend
Abstract:
Abstract Pectus Arcuatum, a rare congenital chest wall deformity, is characterized by the protrusion and early ossification of sternal angle thus configuring as a mixed form of excavatum and carinatum features. Surgical correction of pectus arcuatum always includes one or more horizontal sternal osteotomies, consisting in performing a V-shaped horizontal cutting of the sternum (resection prism) by means of an oscillating power saw. The angle between the saw and the sternal body in the V-shaped cut is determined according to the peculiarity of the specific sternal arch. The choice of the right angle, decided by the surgeon on the basis of her/his experience, is crucial for a successful intervention. The availability of a patient-specific surgical guide conveying the correct cutting angles can considerably improve the chances of success and, at the same time, reduce the intervention time. The present paper aims to propose a new CAD-based approach to design and produce custom-made surgical guides, manufactured by using additive manufacturing techniques, to assist the sternal osteotomy. Starting from CT images, the procedure allows to determine correct resection prism and to shape the surgical guide accordingly taking into account additive manufacturing capabilities. Virtually tested against three case studies the procedure demonstrated its effectiveness. Highlights Patient-specific surgical guide improves the chances of success in sternal osteotomy. A CAD-based approach to design and produce custom-made surgical guides is proposed. The proposed framework entails both a series of automatic and user-guided tasks.Keywords:
Sternum
Operations were performed on 20 children for Pectus excavatum in five years. 'Turn over' of the sternum was chosen as surgical approach. About five years have passed from those operations, and results still are better than those obtained from earlier methods based on stabilisation of the sternum.
Sternum
Cite
Citations (7)
Sternum
Pectus carinatum
Costal cartilage
Median sternotomy
Cite
Citations (78)
The deformity of pectus excavatum causes no organic disease or functional impairment ordinarily, but it does cause a greater or lesser degree of psychologic problems. It should be repaired for the cosmetic effect and for prevention and/or relief of the psychologic problems. It is best to treat the patient at about two years of age, but can be done at any age. The deformed costal cartilages that have been freed in a subperichondral manner are used to fix the sternum in a normal position once the sternum has been elevated to a normal position. A simple, easy, safe operative procedure certain of correcting the deformity has been described using only autogenous tissue for support of the sternum in the elevated position.
Sternum
Funnel Chest
Position (finance)
Cite
Citations (7)
This article reports the experience of using a modified sternal turnover technique in 4 patients with pectus excavatum in which one or both internal mammary vascular pedicles were preserved to assure viability of the sternum and costal cartilages in the everted position. At operation special care was taken in dissecting the mammary vessels which were freed en bloc with the protecting fatty tissue. The internal mammary vessels were carefully dissected upward and downward each for 5 cm and the funnel shaped sternum was turned over for 180 degrees with care being exercised not to injure the blood vessels. We recommend this technique the first choice for the repair of pectus excavatum.
Sternum
Mammary artery
Funnel Chest
Great vessels
Cite
Citations (1)
Sternum
Pectus carinatum
Thorax (insect anatomy)
Cite
Citations (11)
Sternum
Funnel Chest
Position (finance)
Cite
Citations (2)
Pectus excavatum, or funnel chest, is a deformity characterized by depression of the lower sternum and adjacent costal cartilages. The lowest point is at the junction of the xiphoid process and the body of the sternum. It is commonly detected in early infancy, when it is noted that there is paradoxical retraction of the area on inspiration. During the next year or two, the costal cartilages and sternum become fixed, so that the depression is present regardless of the phase of respiration. The early problems are cosmetic and psychological (with effects on both the patient and his parents), but later there is almost inevitably some functional impairment. We have operated on 25 patients with pectus excavatum and are convinced that surgical treatment is remarkably effective and safe. This communication is presented with the hope that more young patients will receive specific corrective measures before anatomic changes have become relatively irreversible
Sternum
Funnel Chest
Depression
Thorax (insect anatomy)
Cite
Citations (7)
Objective To compare the effect of Nuss operation and sternum subvolution with pedicle of rectus abdominis for treatment of pectus excavatum.Methods Clinical data of 30 pectus excavatum patients between January 2008 and August 2012 were retrospectively analyzed.All cases underwent Nuss operation or sternum subvolution with pedicle of rectus abdominis.The differences of their vital clinic index during and after operation were observed and compared.Results The Nuss operation group showed much better results than the sternum subvolution with pedicle of rectus abdominis group in terms of operation time,intra-operative blood loss,hospital stay after operation,duration of post-operative pain,incidence of complications and score of operation outcome.Conclusion Nuss operation can correct the pectus excavatum malformation to a great degree.It is better than sternum subvolution with pedicle of rectus abdominis in effect.It should be recommended for further promotion and application.
Sternum
Nuss Procedure
Rectus abdominis muscle
Cite
Citations (0)
Objective: Pectus excavatum is relatively common congenital chest deformity that is often accompanied by physical and psychological impairment. The surgical methods for pectus excavatum repair are the subject of some controversy. We review our experience using a procedure in which the introduction of exogenous material is unnecessary. Methods: From July 1993 to March 2008, 113 patients underwent surgical repair of pectus excavatum. Sterno-costal elevation was adopted for 102 patients, including all of the paediatric patients and most of the adults. Sternal turnover was employed for 11 adult patients with severe asymmetric deformities. In sterno-costal elevation, a section of the third or fourth to the seventh costal cartilages as well as the lower tip of the sternum below the sixth cartilage junction are resected, and all of the cartilage stumps are re-sutured to the sternum. The secured ribs generate 0.5–10 kg of tension, pulling the sternum bilaterally, such that the resultant force causes the sternum to rise anteriorly. These forces are sufficient to correct the deformities and to prevent flail chest. In sternal turnover, the sternum is cut at the third intercostal space. The lower part of the sternum is turned over and fixed to the upper sternum with an overlap of 1 cm. Sections of the third to the seventh rib cartilages are resected and affixed in the same fashion as in sterno-costal elevation. Results: There were no operative deaths, and in all cases the deformities were corrected satisfactorily. Ninety-nine patients (88%) were graded as Excellent, and the remaining 14 (12%) were graded Good. None of the patients developed any life-threatening complications. No patient reported residual pain. No re-operations were required for any reasons. The patients resumed daily activities of all types, including contact sports, within 3 months after surgery. Conclusions: We believe that morbidity is one of the most important factors to be considered in operative invasions. Our technique represents a less-invasive and lower-risk procedure for the repair of pectus excavatum in any age group.
Sternum
Costal cartilage
Funnel Chest
Thorax (insect anatomy)
Thoracic wall
Cite
Citations (7)
Objective:To investigate the effect of elevating stermum on the congenital pectus excavatum.Methods:75 cases of children congenital pectus excavatum were treated by modified traditional Ravitch procedure: elevating sternum stabilized with the steel bar behind sternum and the data of follow-up were retrospectively analyzed.Results:Except two cases of the bar displacement early in postoperation,the operations in other patients were successful with good repair and no complication.66 cases were followed up for 1/2 to 11 years.The chest walls were normal except for 3 cases of slight introcession of anterior chest wall.Conclusions:The children congenital pectus excavatum treated by modified Ravitch procedure showed no complication and good orthopedic effect.
Sternum
Pectus carinatum
Cite
Citations (0)