Mark M. Ravitch MD: Surgeon, author, teacher, soldier.

Mark M. Ravitch (1910-1989) was the most prolific surgeon-author of the 20th Century as well as an outstanding clinical surgeon, scholar, historian, and researcher. While today he would not be considered a "pure pediatric surgeon," he was a charter member of the American Pediatric Surgical Association and received the William E. Ladd medal from the Surgical Section of the American Academy of Pediatrics and the Denis Brown Medal from the British Association of Pediatric Surgeons. He contributed to the treatment of benign colon and rectal disease, intussusception, and chest wall deformities. His most enduring contribution was surgical stapling, a technology that he brought from Russia during the Cold War that opened the door to minimally invasive surgery.

Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes.

Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Experiencia con la construcción quirúrgica de las deformidades de la pared torácica / Surgical experience with reconstruction of chest wall deformities

Analizar las características clínicas, indización para realizar la intervención y los resultados de la cirugía de pacientes con deformidades de la pared torácica. Métodos: Con el fin de obtener la informaci¢ón, se analizaron 32 expedientes clínicos que pudieron ser ubicados y la información incluida en la base de datos del servicio de otros 13 pacientes operados en el servicio de cirugía de tórax del Hospital Rafael Angel Calderón Guardia por Pectus Excavatum o Pectus Carinatum, desde enero de 1998 a enero del 2010. Resultados: Se encontraron 29 pacientes operados por Pectus Excavatum y 16 por Pectus Carinatum, de los cuales 37 fueron varones y 8 mujeres. La edad osciló entre 13 y 24 años con un promedio de 16 años. En 28 pacientes la única indicación para la cirugía fue la afección sicológica causada por la deformidad y en 17 se presentó además algún síntoma como disnea con el ejercicio, dolor torácico o palpitaciones. En 26 de los 29 pacientes operados por Pectus Excavatum se utilizó una barra de metal para manetener el esternón reducido en posición normal mientras se consolidaban retirándola a los seis meses y en los últimos tres las reducción se efectuó con una malla de polipropileno que funcionó igual, pero con la ventaja que no requiere reintervención para retirarla. Los resultados se evaluaron en forma subjetiva de acuerdo a la satisfacción manifestada por el paciente y a la nota del médico; encontrando en un caso de Pectus Excavatum recidiva de la...