Management of congenital chest wall deformities

Abstract

Congenital chest wall deformities are considered to be anomalies in chest wall growth. These can be categorized as either rib cage overgrowth or deformities related to inadequate growth (aplasia or dysplasia). Rib cage overgrowth leads to depression of the sternum (pectus excavatum) or protuberance of the sternum (pectus carinatum) and accounts for greater than 90% of congenital chest wall deformities. The remaining deformities are a result of inadequate growth. Evolution in the management of congenital chest wall deformities has made significant progress over the past 25 years. This article will review chest wall deformities and the current management strategies of these interesting anomalies.

Keywords: Congenital; chest wall; deformity; pectus.

Figures

Figure 1

Modified Ravitch procedure for pectus excavatum. (a) Inframammary skin incision. (b) Subperichondrial dissection and exposure of costal cartilage. (c) Resection of 3rd, 4th, and 5th costal cartilages. (d) Appearance after repair.

Figure 2

Nuss repair of pectus excavatum. (a) Severe pectus excavatum in a teenage girl. (b) Placement of pectus bar in the retrosternal plane. (c) Bar in place and ready to be flipped. (d) Final appearance.

Figure 3

Open repair of pectus carinatum. (a) Preoperative appearance. (b) Subperichondrial cartilage resection and correction of sternal angulation with cartilage interposition. (c) Postoperative appearance.

Figure 4

Congenital diaphragmatic hernia. (a) Chest radiograph depicting a left-sided CDH (note the bowel gas pattern in the left hemithorax). (b) Right-sided CDH defect after reduction of herniated liver. (c) Pledgetted repair of left CDH defect.

Figure 5

Staged repair of ectopia cordis. (a) Thoracoabdominal ectopia cordis (note the thin layer of skin covering the eviscerated heart and bowel). (b) Placement of tissue expanders. (c) Appearance of expanded skin after 6 weeks. (D) Soft tissue coverage of defect.