[Re-operation of pectus excavatum]

Area of Science:

• Thoracic surgery
• Pediatric surgery
• Cardiothoracic surgery

Background:

• Surgical reconstruction of deformed thoracic cages, particularly pectus excavatum, is complex.
• Recurrence of anterior chest wall deformities after initial surgery necessitates further intervention.

Observation:

• Postoperative recurrence of pectus excavatum is often linked to inadequate costal cartilage resection.
• Low sternal transection during sternal turnover procedures can lead to upper anterior chest wall depression.
• In pediatric patients, overgrowth of upper costal cartilages after sternal turnover can cause paradoxical posterior sternal displacement and chest wall depression.

Findings:

• A modified sternal turnover technique involving sternal overlap is proposed for pectus excavatum repair.
• This technique facilitates precise determination of costal cartilage resection and effective reconstruction of anterior chest wall depression.
• Re-operative findings suggest the modified sternal turnover technique does not compromise sternal blood supply or development.

Implications:

• The recommended surgical modification aims to reduce the incidence of postoperative pectus excavatum recurrence.
• This approach offers improved aesthetic and functional outcomes for anterior chest wall reconstruction.
• The findings support the safety and efficacy of the sternal turnover technique with overlap in complex cases.