Abstract
Background: Acquired chest wall deformities are difficult to describe and to classify. We propose the following classification and treatment options. Methods: We observed 11 patients with acquired deformities (AD) that required surgical correction. Results: AD of the chest can be classified into 4 groups: (1) AD resulting from a pathological process within the thorax (heart enlargement, mediastinal tumors), (2) AD resulting from chest wall disease (rib osteomyelitis or tumors), (3) iatrogenic deformities (following rib graft harvesting, acquired Jeune's syndrome), and (4) post-traumatic deformities. Group 1 requires treatment of the pathological process. Group 2 is guided by oncological or infectious disease principles. Groups 3 and 4 require chest wall reconstruction. Iatrogenic AD usually occur after pectus excavatum repair with rib cartilage extirpation in young patients, which results in a reduced, restricted thorax. Post-traumatic AD often have pathological chest wall mobility owing to pseudo-articulation of injured ribs. Conclusions: To prevent AD formation and to protect thoracic growth and mobility, costosternal and costochondral junctions should be preserved during cartilage resection. Substernal suturing of the perichondrium should be avoided.
Key words
Iatrogenic - post-traumatic - chest wall deformities - pectus excavatum
References
-
1 Shamberger R C, Hendren III W H. Congenital deformities of the chest wall and sternum. Pearson FG, Cooper JD, Deslauriers J, Ginsberg RJ, Hiebert CA, Patterson GA, Urschel HC, eds. Thoracic Surgery. Philadelpha, PA; Churchill Livingstone 2002: 1351-1373
-
2
Robicsek F, Fokin A A.
Surgical correction of pectus excavatum and carinatum.
J Cardiovasc Surg.
1999;
40
725-731
-
3
Haller Jr J A, Colombani P M, Humphries C T, Azizkhan R G, Loughlin G M.
Chest wall constriction after too extensive and too early operations for pectus excavatum.
Ann Thorac Surg.
1996;
61
1618-1624
-
4
Milovic I, Oluic D.
The effect of the age of the child at the time of surgery for pectus excavatum on respiratory function and anthropometric parameters of the thorax.
Acta Chir Iugosl.
1990;
37
45-52
-
5
Robicsek F, Fokin A A.
How not to do it: restrictive thoracic dystrophy after pectus excavatum repair.
Interactive Cardiovasc Thorac Surg.
2004;
3
566-568
-
6
Shannon J P, Sparks C H.
An improved method for repair of pectus chest deformities.
Ann Thorac Surg.
1973;
16
629-634
-
7
Ravitch M M.
Invited editorial comment.
Arch Surg.
1978;
113
1437
-
8
Bairov G A, Fokin A A.
Keeled chest.
Vestn Khir.
1983;
130
89-94
-
9
Haje S A.
Iatrogenic pectus carinatum. a case report.
Int Orthop.
1995;
19
370-373
-
10
Prabhakaran K, Paidas C N, Haller J A, Pegoli W, Colombani P M.
Management of a floating sternum after repair of pectus excavatum.
J Pediatr Surg.
2001;
36
159-164
-
11
Alexander J.
Traumatic pectus excavatum.
Ann Surg.
1931;
93
489-500
-
12
Fokin A A.
Post-traumatic carinatum deformity of the chest.
Vestn Khir Im II Grek.
1982;
129
86-87
-
13
Peltomäki T, Häkkinen L.
Growth of the ribs at the costochondral junction in the rat.
J Anat.
1992;
181
259-264
-
14
Gruber H E, Rimoin D L.
Quantitative histology of cartilage cell columns in the human costochondral junction: findings in newborn and pediatric subjects.
Pediatr Res.
1989;
25
202-204
-
15
Martinez D, Juame J, Stein T, Peña A.
The effect of costal cartilage resection on chest wall development.
Pediatr Surg.
1990;
5
170-173
-
16
Ohara K, Nakamura K, Ohta E.
Chest wall deformities and thoracic scoliosis after costal cartilage graft harvesting.
Plast Reconstr Surg.
1997;
99
1030-1036
-
17
Hannam S, Greenough A, Karani J B.
Rib abnormalities arising before and after birth.
Eur J Pediatr.
2000;
159
264-267
-
18
Fokin A A.
Pouter pigeon breast.
Chest Surg Clin N Am.
2000;
10
377-391
-
19
Shamberger R C.
Cardiopulmonary effects of anterior chest wall deformities.
Chest Surg Clin N Am.
2000;
10
245-252
-
20
Fonkalsrud E W.
Open repair of pectus excavatum with minimal cartilage resection.
Ann Surg.
2004;
240
231-235
-
21
Xu Z C, Hu T Z, Zhang Y Z.
Effect of costal perichondrium on regeneration and remodeling of costal neocartilage.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.
2001;
15
363-365
-
22
Randolph J G, Tunell W P, Morton Jr D.
Repair of pectus excavatum in children under 3 years of age: a twelve-year experience.
Ann Thorac Surg.
1977;
23
364-366
MD, PhD Alexander A. Fokin
Carolinas Medical Center
1000 Blythe Blvd.
Charlotte, NC 28203
USA
Phone: + 7043553200
Fax: + 70 43 55 14 35
Email: Alexander.Fokin@carolinashealthcare.org
