A new method of reconstruction for pectus excavatum that preserves blood supply and costal cartilage.

Abstract

We began in 1982 to use a modified Ravitch procedure that preserves the blood supply to the sternum to correct funnel chest deformities, but there were some problems such as postoperative paradoxical respiration, chest wall irregularity, and palpable heart beat. To resolve these problems, the concept of Jensen's procedure was incorporated into the authors' previous method. In Jensen's method, only a small portion of the deformed cartilages is resected, and almost all of them are preserved. A preformed stainless steel strut is used for chest wall stabilization. The authors preserved the costal cartilages in a manner similar to Jensen's, but the anterior chest wall was stabilized with miniplates and Kirschner wires instead of a large retrosternal strut. The xiphoid process with the lower end of the sternum was detached and moved cephalad. None of the patients developed respiratory failure postoperatively. Although the follow-up periods were short, satisfactory results were obtained with no recurrence of the deformities. The main advantages of our procedure are (1) basic blood supply to the chest wall is preserved, (2) stability of corrected chest wall is maintained with miniplates and Kirschner wires without a large metallic strut, and (3) preserved costal cartilages make the chest wall rigid and the incidence of respiratory failure low. We conclude that this method is simple and produces satisfactory results with a rigid chest wall.