Regenerative Surgery in the Treatment of Cosmetic Defect Following Nuss Procedure

In the past decade, the minimally invasive repair of pectus excavatum (MIRPE) has become the treatment of choice for severe pectus excavatum (PE), proving acceptable to excellent cosmetic results. Recently, autologous fat grafting (FG) has been identified in aesthetic and reconstructive surgery to ideally handle volume and contour defects. We report our experience about FG in the treatment of residual minor defects after MIRPE and a proposal for a new indication of this largely adopted technique.

From April 2012 to April 2015, 127 patients underwent bar removal. At outpatient check, a questionnaire was adopted to investigate aesthetic outcome prior and after surgery (3 months postoperation); scoring options varied from 4 to 0 [4, excellent; 3, very good; 2, good; 1, acceptable; and 0, unacceptable]. In patients scoring less than "good," we proposed FG at the same operating session of bar removal. The donor areas were the abdomen, trochanteric region, and inner thigh. The tissue was gently collected through a thin cannula, filtrated, and then promptly injected into the defect.

Eleven patients (8.8%) have been selected for FG. No complications have been detected during the follow-up period (range 1-36 months). In three cases, we performed further FG procedure to achieve an optimal result. Questionnaire reported an increased mean score from 1.8 to 2.7.

In our early experience, FG has provided satisfactory cosmetic results. With the present report we advocate FG as a minimally invasive "tool" to achieve better defect correction after MIRPE. These preliminary results suggest that FG could be a worthwhile resource in treating chest wall malformations.