ABSTRACT
Background: We herewith describe the technique we used in the one-setting surgical correction of different types of congenital chest wall [sternal or rib deformities]: deficient ribs or sternum; pectus excavatum, and the pectus carinatum defects
Patients and Methods: Our study was prospectively-undertaken from 2003 till 2006, in Kasr El Aini University Hospitals, Abul Reesh National Insurance Hospital for Students, and Tanta University. It enrolled 12 patients [7 males and 5 females] having 3 types of congenital sternal deformities: Cleft or Deficient Sternum [DS] [5 patients, 41.6%]; Pectus excavatum [PE] [6 patients, 50%]; and Pectus carinatum [PC] [1 patient, 8.3%]. Our youngest patient - at the time of surgical correction - was a 4 months-old male baby with deficient sternum; while the oldest was a 15-years old young man with pectus carina- tum. The mean age of our patients was 4 years +/- 5.5 months [range 4 months - 15 years]. Patients having PE [or their parents] mainly complained of cosmetic deformity followed by recurrence of chest infection; while CS patients [or their parents], expressed fear of possible trauma to the inadequately-protected heart. Follow-up period was done for all patients for a whole year postoperatively by means of clinical examination and questionnaire questions to the patient [or his or her relatives] asking them to share in the patients evaluation in comparison with the original complaint stating their opinion in grades as : excellent, good, fair [or accepted], and poor
Results: We had no mortality. No significant intraoperative morbidities were found. Blood loss was minimal and no transfusion was required. Postoperatively, transient mild unilateral seroma below the pectoralis muscle [needed a 5-days vacuum drainage] was noticed in 1 patient [8.3%]; mild Chest wall pain [ameliorated by oral and local analgesia] in 1 patient [8.3%]; and lag of cartilage regeneration leading to small anterolateral soft space [managed with increased oral calcium intake] in another patient [8.3%]. No other types of morbidity occurred eg: blood loss needing transfusion; Cardiac arrhythmias; or recurrence of sternal depression [pectus cases]. Postoperative hospital stay time was relatively short with a mean of 8 k 3.5 days [range 4 -13 days]. According to the patients [and or childis parents] words, the postoperative functional results were described as: excellent in 6 patients [50%]; good in 4 patients [33.3%]; and acceptable in 2 patients [16.6%]. Generally-speaking, patients and or their parents accepted the surgical results quite well and reported an obvious decline in the frequency of chest infections, and a favorable improvement in morals together with an increased tolerance for prolonged physical activity
Conclusion: our immediate and short-term results showed that marked congenital sternal de- formities should be surgically corrected once diagnosed after stabilization of the patients clinical condition. The technique[s] we used achieved adequate stabilization with a sound degree of patient safety. The postoperative results were satisfactory and acceptable for surgeons, patients, and their relatives. Longer follow-up results are still awaited