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Pectus excavatum (also known as funnel chest or chondrosternal depression), the most common congenital chest wall deformity, involves depression or inward caving of the anterior chest wall. The abnormality is caused by overgrowth of the costal cartilages. The author's experience has been limited to teenagers and adults. In these populations, surgical repair is recommended for severe deformation or for a defect associated with cardiopulmonary symptoms. However, most studies have failed to document consistent improvement in cardiopulmonary function resulting from surgical repair. Cosmesis is certainly a valid indication for surgery, especially when the appearance of the deformation affects the patient's wellbeing.
Although computed tomography with three-dimensional reconstruction provides a satisfactory way to compare the anatomy before and after surgical correction, physical examination is essentially all that is needed to confirm a diagnosis of pectus excavatum and establish indications for surgical correction. Associated conditions include Marfan's syndrome and scoliosis. All patients with Marian's syndrome or marfanoid body habitus should be evaluated, but fewer than 5% of patients with scolosis are sufficiently affected to warrant evaluation.
A thoracic epidural catheter is encouraged for pain control. Ambulation is initiated on the first postoperative day. Usually drains are removed after 48 hours and the patient is dismissed within 4—5 days after the operation. After a month of recovery, contact sports are allowed provided that the patient wears a custom-made protective shell for a year. The pin is usually kept in place for at least 6—9 months and is removed under local anesthesia after that period.
Major complications are extremely rare. Minor complications include superficial wound infection, seroma, and displacement of the metallic pin, requiring replacement or early removal. Most patients (85%) experience improvement and express gratitude that the deformation has been corrected.
Haller Jr, JA
Evolving management of pectus excavatum based on a single institutional experience of 664 patients.