Protrusion and mixed deformities

Considerable confusion is encountered in the literature relating classification respectively surgical repair of the anterior chest wall deformities in view of the asymmetric types which are arbitrarily ranged in one of the two main groups (impressions, protrusions).

Out of 420 operations 89 (21%) were performed for pure protrusion, and 64 (15%) for mixed deformities, with asymmetric impression and protrusion present at the same time. Mixed deformities were limited to the parasternal area in 10 and extended to the entire anterior chest wall in 54 cases. Surgery was undertaken for both protrusion and mixed deformities beyond 10 years of age in 9.8%, while for a typical funnel chest deformity in 31% (p<0.001). Correction has been achieved performing double subperichondral excisions of the distorted cartilages and - if necessary - subperiosteal wedge incision of the bony segments, completed by a T shape wedge sternal incision. In order to preserve the repaired position a stainless steel stabiliser was introduced for one year behind the sternum and the entire mobilised wall area.

This method was used hitherto in 60 patients with mixed, respectively severe funnel chest deformities without any complication. The "pectus index" calculated according to the equation A/Bx100, in which A is the internal sterno-vertebral distance and B is the transverse diameter of the chest at the level of the diaphragms in cm (normal values: 35%-45%) was followed for 7.6+/-4.5 years in 63 patients. The preoperative 53+/-7.6% decreased to 44.2+/-6.3% (p<0.05).