Funnel chest is a congenital deformity of the chest wall in which abnormal growth of the sternum and several ribs causes the anterior chest wall to appear caved-in. Almost all deformities of the chest wall are caused by funnel chest syndrome, and it occurs once in every 300 to 400 births.
Instructions
1. Consider a minimally invasive repair for preadolescent children. The Nuss procedure involves inserting a curved metal bar under the sternum through lateral chest incisions. This immediately corrects the chest depression and the bar can be removed within three years.
2. Address complications of the Nuss procedure. This is most frequently a displacement of the bar or a pneumothorax, both of which can require a second operation to correct.
3. Implement modifications to avoid bar displacement. The use of a lateral stabilizing device may reduce the chances of bar movement, and some surgeons also use a three-point fixation method to further prevent the bar from moving. In this technique, the surgeon uses thoracoscopy to place a stitch around a rib and the bar next to the sternum.
4. Perform open surgical repair of the sternum in most cases of funnel chest syndrome. There are several possible approaches, but the most common technique in the United States combines three procedures. These consist of a posterior sternal osteotomy, subsequent resection of the deformed cartilage and an oblique division of the affected ribs.
5. Treat any postoperative complications of open surgical repair. These occur in less than 10 percent of cases, but the most common complication is a pneumothorax, which may require a second operation.
Tags: chest wall, chest syndrome, funnel chest, funnel chest syndrome, most common, Nuss procedure