Chest wall surgery: Nuss technique for repair of pectus excavatum in adults

Pectus excavatum is a congenital deformity of the thoracic wall consisting in the concavity of the sternum and of the costal cartilages. The standard operative treatment of pectus excavatum has been the Ravitch's technique that requires the exposition of the thorax's anterior region with resection of the costal cartilages affected bilaterally, the performance of a cross sternal osteotomy with the placing of a stabiliser, and the development of muscular flaps. The conviction that the correction of the pectus excavatum is essentially aesthetic led Donald Nuss to put forward a new procedure by means of minimally-invasive surgery based on the skeleton's malleability and remodelling capacity applied to the thorax. Thus he designed a technique consisting of a retrosternal steel bar that would modify the concavity of the sternum while maintaining the contour of the reformed thorax, all done by means of two small incisions on each side of the thorax with the help of the thoracoscope. The maintenance of the bar for 2 or 3 years, and its posterior removal, results in 95% of the cases in a corrected thorax with a considerable aesthetic improvement.