Surgical repair of pectus excavatum and carinatum

The author discusses different forms of pectus deformities and presents appropriate surgical methods he developed for their correction. For pectus excavatum, the surgical technique includes conservative sub-perichondral resection of deformed costal cartilages and detachment of the xiphoid process. A transverse sternotomy is performed at the upper level of the deformed sternum, which is then bent forward. The corrected sternal position is secured by a "hammock" of synthetic mesh, spread behind the sternum, and attached to the respective cartilage remnants. The pectoralis muscles are then united presternally. The initial steps of pectus carinatum correction are similar to that of pectus excavatum. The sternum, however, is not freed of its environment. A length of 3-4 cm is resected from the distal sternum and the xiphoid process is reattached in the proper anatomical direction. Measures to correct different anatomical varieties, such as pouter pigeon breast, asymmetrical pectus excavatum, and carinatum, are discussed individually.