Management of deep pectus excavatum (DPE)

Jose Ribas Milanez de Campos, Miguel Lia Tedde, Jose Ribas Milanez de Campos, Miguel Lia Tedde

Abstract

The correction of deep pectus excavatum, with the Nuss procedure, frequently require a series of maneuvers that is inherently dangerous. Herein we describe 10 technical modifications to prevent potential complications. These modified techniques have certain advantages and according to the authors, with these maneuvers the risk of pericardial sac, cardiac injury, bar displacement and complications during the removal of the bar could be markedly reduced.

Keywords: Nuss procedure; Pectus excavatum; anthropometric index; crane technique.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Anthropometric index = measurement of distance (A) and (B).
Figure 2
Figure 2
Surgical position.
Figure 3
Figure 3
The Langenbeck retractor lifts the chest wall.
Figure 4
Figure 4
Vacuum bell intraoperatively.
Figure 5
Figure 5
Steps for the Park Crane technique.
Figure 6
Figure 6
Sternal elevation during MIRPE.
Figure 7
Figure 7
Position of the skin marks and starting from the left side.
Figure 8
Figure 8
One stabilizer is placed on each side of the bar as close as possible to the hinge point to avoid bar displacement.
Figure 9
Figure 9
Two bars and four stabilizers as a bridge linking the bars.
Figure 10
Figure 10
A longitudinal incision made over a short midline to remove short segments of costal cartilages.
Figure 11
Figure 11
Combination approach, MIRPE and minimal cartilage resection.
Figure 12
Figure 12
Rubber film protection in a previous aligned bar.

Source: PubMed

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