Modified sandwich technique for asymmetric pectus carinatum and excavatum-carinatum complex: A retrospective cohort...

Asymmetric pectus carinatum (PC) and excavatum-carinatum complex (ECC) represent challenging chest wall deformities in which conventional bracing or single-direction minimally invasive techniques may fail to achieve satisfactory correction. The modified sandwich technique allows multidirectional remodeling of the anterior chest wall using combined internal and external bar placement; however, technical aspects such as bar number, length, placement sequence, and fixation remain insufficiently defined.

A retrospective analysis was performed on 55 patients who underwent repair using the modified sandwich technique. Demographic data, deformity characteristics, operative details (bar number, length, configuration, fixation strategy), and postoperative outcomes were evaluated. Complications, need for revision, bar removal timing, and long-term follow-up results were recorded. Data were summarized using descriptive statistics; continuous variables are presented as mean ± SD or median (range) and categorical variables as n (%). Where applicable, groups were compared using the Mann-Whitney U test; p < 0.05 was considered statistically significant.

The cohort consisted predominantly of ECC patients (98 %), with asymmetric deformity observed in most cases. Between 2013 and 2024, 55 patients who underwent repair using the modified sandwich technique were included in this retrospective analysis, with a mean follow-up of 97.7 months (range: 15-118 months). Two bars were sufficient in 90.9 % of patients, while three bars were required in selected extensive deformities. External bars used for PC correction were generally longer than internal bars used for PE correction (mean difference 41.5 mm). Mean operative time was 91.7 min, and mean hospital stay was 4.15 days. Minor complications occurred in 14.6 % of patients, and major complications requiring revision occurred in 5.5 %. No mortality was observed. Long-term follow-up demonstrated durable correction without recurrence in the majority of cases.

The modified sandwich technique is a safe and effective option for selected complex pectus carinatum and excavatum-carinatum complex deformities. Individualized planning of bar number, length, and fixation strategy is essential to optimize outcomes and minimize complications.