Pectus excavatum repair from a plastic surgeon's perspective

Area of Science:

• Thoracic surgery
• Plastic and reconstructive surgery
• Pediatric surgery

Background:

• Minimally invasive repair of pectus excavatum (MIRPE) can result in inadequate aesthetic outcomes, particularly in specific anatomical regions.
• Challenges include diaphragmatic interference, residual asymmetry, and potential recurrence after bar removal.
• Secondary procedures are complicated by adhesions from prior interventions.

Purpose of the Study:

• To review and illustrate ancillary reconstructive techniques for secondary pectus excavatum correction.
• To provide guidance on selecting appropriate surgical methods for diverse PE presentations.
• To discuss the advantages and disadvantages of various secondary correction strategies.

Main Methods:

• Review of established and advanced reconstructive techniques for pectus excavatum.
• Discussion of open surgery, cartilage manipulation, liposhifting, and alloplastic implants.
• Emphasis on tailoring techniques to individual patient needs and deformity characteristics.

Main Results:

• Various secondary correction options exist, including open repair, cartilage reshaping, autologous grafts, liposhifting, and alloplastic materials.
• Each technique offers specific benefits and drawbacks for addressing residual concavity and asymmetry.
• Successful secondary correction requires a comprehensive understanding of reconstructive options.

Conclusions:

• No single technique is universally applicable for all pectus excavatum deformities.
• A combination of primary repair and ancillary reconstructive procedures may be necessary for optimal aesthetic results.
• Surgeons must be proficient in diverse shaping and reconstruction methods to manage complex anterior chest wall deformities.