Results of pectus excavatum correction using a minimally invasive approach with subxyphoid incision and three-point fixation.

OBJECTIVES: This study reviews the results of our previously described modification of the minimally invasive (Nuss) procedure for correction of pectus excavatum. It utilizes a subxyphoid incision with central fixation to maximize safe bar passage and minimize bar displacement. METHODS: Consecutive patients corrected with the modified Nuss procedure between 2010 and 2015 form the basis of this study. RESULTS: During the study period, 73 patients had correction of their pectus excavatum by the modified Nuss procedure, utilizing subxyphoid incision and central fixation. Average age was 14.3 (range 8-19). 54 patients were male, 19 female. The average Haller index was 4.3 (range 3.2-7.2). No episodes of cardiac perforation, hemothorax or significant pneumothorax were recorded. Bar displacement occurred in two patients (2.7%) with one late recurrence after bar removal. CONCLUSIONS: Our modification of the Nuss procedure is effective at preventing intrathoracic complications and cardiac perforation. Central fixation had a lower rate of bar displacement compared to published reports. Additional efforts are needed to further reduce bar displacement.

Simplifying cheek reconstruction: a review of over 400 cases.

BACKGROUND: The cheek is a vast, well-vascularized facial subunit defined by the preauricular crease laterally, the mandible inferiorly, the lips and nasolabial fold medially, and the orbit-cheek crease and zygomatic arch superiorly. Reconstruction of the cheek commonly takes advantage of skin laxity in older patients and the relaxed skin tension lines of the face. Poor reconstructive techniques can cause or exacerbate significant deformities, especially in the oral and ocular regions. METHODS: Four hundred twenty-two cases of post-Mohs' cheek reconstruction were reviewed retrospectively. All cases were performed sequentially over 10 years by the senior author (J.F.T.). Indications, techniques, postoperative care, complications, and patient characteristics (e.g., age, sex, medical history, defect size, and skin quality) were taken into consideration for each case. RESULTS: The procedures used for cheek reconstruction included direct closure (53 percent), cervicofacial advancement flaps (19 percent), perialar crescentic advancement flaps (8 percent), full-thickness skin grafting (8 percent), V-Y advancement flaps (2 percent), and free flaps (1 percent). Although no attempt was made to modify patients' anticoagulation status before surgery, no hematomas were reported. Nine patients had multiple procedures for cancer recurrence or new defects, and all but four operations were performed at a university hospital outpatient surgery center. Seventeen total complications were noted from distal flap necrosis (n = 2), ectropion (n = 7), wound healing (n = 7), and compromised vascular supply (n = 1). CONCLUSION: Knowledge of aesthetic considerations and appropriate use of operative techniques yield optimum cheek reconstruction defined by successful wound closure, thoughtful scar placement, and minimal postoperative complications.