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Operative Management of Pectus Arcuatum: a Minimally-Invasive Approach.
Nathaniel Roberson, MD; Rebeccah L. Brown, MD; Victor F. Garcia, MD; Ann Schwentker, MD
University of Cincinnati
2023-01-31
Presenter: Nathaniel Roberson MD`
Affidavit:
Agree
Director Name: Ann Schwentker MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background/Purpose
Pectus arcuatum is a rare chest wall deformity wherein Nuss bar placement may accentuate the superior sternal prominence. Traditional Ravitch repair involves a large median sternotomy or clamshell incision. We report results of a novel minimally-invasive approach combining anterior wedge osteotomy of the sternum and contouring of the prominent costal cartilages with Nuss bar placement for the surgical management of pectus arcuatum.
Methods
A chart review of all patients with pectus arcuatum managed with a minimally-invasive surgical approach at our institution from 2018 to 2022 was performed. Demographic data, presenting symptoms, surgical treatment, complications and outcomes were collected.
Results
Eight patients, five (62.5%) male, with a mean age of 14 years (8-18) at time of surgery were included in the study with a mean length of follow-up of 8 months. Average pre-operative Haller index was 3.45 (2.8-4.3). Plastic surgery performed sternal osteotomy and fixation and costal cartilage contouring, with Nuss bar placement by pediatric surgery. Mean length of hospital stay was 3.0 days, which is similar to length of stay for Nuss bar placement alone at our institution. Pain requirements were not increased over Nuss bar alone, but operative times were longer. There were three patients with minor complications (all superficial wound infections) that did not require operative take-back. All patients and parents reported cosmetic improvement.
Conclusion
The described minimally-invasive surgical procedure performed for correction of pectus arcuatum results in symptomatic and cosmetic improvement and does not increase morbidity in pectus repair.
