Wire fracture in postoperative Nuss procedure: a problem that cannot be ignored.

Area of Science:

• Thoracic surgery
• Pediatric surgery
• Biomaterials in surgery

Background:

• Surgical stainless wire is standard for pectus bar and rib stabilization in Nuss procedures.
• Wire fracture and associated complications are significant but often overlooked issues.
• This study addresses the critical problem of wire breakage in pectus excavatum repair.

Purpose of the Study:

• To highlight the incidence and implications of surgical wire fractures during the Nuss procedure.
• To introduce and evaluate modified fixation techniques using polyblend polyethylene sutures (PDS) to prevent wire breakage.
• To share clinical experience and recommendations for improving pectus excavatum correction outcomes.

Main Methods:

• A retrospective study of 44 patients undergoing Nuss procedure from September 2011 to January 2020.
• Group A (n=25) used only stainless wires for fixation; Group B (n=19) used stainless wires combined with PDS sutures.
• Data collected included patient demographics, Haller index (HI), wire fracture rates, and operation times.

Main Results:

• Wire fracture occurred in 88% of patients in Group A, with significantly longer operation times for removal (104.6±42.8 min).
• In Group B, all wires remained intact, and no bar displacement or major complications were noted.
• No significant difference in Haller index or patient demographics was observed between groups.

Conclusions:

• Wire fracture during pectus bar fixation presents a substantial risk to patients undergoing the Nuss procedure.
• Utilizing a combination of stainless wires and PDS sutures for pectus bar fixation effectively prevents wire fracture.
• Modified fixation strategies, including PDS, enhance pectus bar stability and mitigate risks associated with wire breakage.