CHAPTER 11 Surgical Treatment of Chest Wall Deformities
Nuss Procedure
Step 1: Surgical Anatomy
♦ Pectus excavatum is the most common chest wall deformity in children. Its incidence is estimated at approximately 1 in 100 children, and it has a male-to-female ratio of 3-4:1.
Step 2: Preoperative Considerations
♦ A complete history and physical examination are performed on all patients. All patients are encouraged to perform exercises designed to strengthen the chest and back muscles and improve exercise tolerance, along with maintaining proper posture.
♦ Determination of a severe pectus excavatum and the need for repair includes two or more of the following criteria:
♦ Our experience has shown that the optimal age for repair is 10 to 14 years because patients’ chests are still soft and malleable. At this age, they show quick recovery, a rapid return to normal activities, and excellent results. After puberty, the flexibility of the chest wall is decreased and often requires the insertion of two bars. It also takes the patients longer to recover at this age. However, we have performed the procedure in patients up to age 31 years with good results.
Step 3: Operative Steps
Anesthetic Induction
Before Incision
♦ The length of the pectus bar is determined by measuring the distance from the right midaxillary line to the left midaxillary line and subtracting 2 cm or 1 inch. The measurement is done over the area of the deepest depression that is still part of the sternum.