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MU pediatric surgeon offers alternative approach to correcting sunken chest
“Pectus excavatum is a deformity of the chest and is sometimes referred to as sunken chest,” said Ramachandran. “The condition occurs when the mid-portion of the chest, or sternum, sinks in and puts pressure on the heart and lungs. It is important to note that even though the condition does present a cosmetic issue, it can also cause breathing problems as well as chest pain.” Pectus excavatum affects approximately one in every 1,000 children and is more common in males than in females. The condition is caused by abnormal growth of the cartilage that attaches the ribs to the sternum. Although the condition may not present problems during infancy or early childhood, the symptoms may become more noticeable and severe as the child gets older. The traditional repair of this condition requires a large incision the length of the sternum for the removal of the deformed cartilage. The sternum is then fractured to reposition the chest bone and a metal strut is inserted to hold the repair in place. The strut is then surgically removed after approximately one year. Activities such as contact sports and heavy lifting should be avoided during this period. The healing process usually takes three to six months. In contrast, the minimally invasive Nuss procedure performed by Ramachandran requires two small incisions, one on each side of the chest, and a curved stainless steel bar that is passed behind the sternum to reform the breastbone. The bar is individually shaped to each patient, and once in place, it is then rotated so that the sternum is pushed out and into a more natural shape. The bar remains in the patient for approximately two years and is surgically removed when the breastbone is permanently reformed. Patients who undergo the Nuss procedure are restricted from certain activities for three months after surgery. After that, they may return to full activity. “I have always had breathing issues,” said Patrick Vining, a patient of Ramachandran who has undergone the Nuss procedure. “But it didn’t show up physically until I was about 11. So before that, I just thought the breathing difficulties had to do with my asthma.” “We started noticing that his chest was caved in somewhat, so it looked kind of like a bowl shape,” said Lisa Flynn, Patrick’s mother. “We always thought that it was from him being thin and didn’t know that there was anything really wrong with him. He had always had breathing problems, and we associated that with his asthma. We were seeing a pediatrician, and he had mentioned to us about what he saw. He put a name to it and told us there was a way to fix it.” Although pain is an expected post-operative side effect, the Nuss procedure results in a much shorter operating time, reduced blood loss and early return to full activity because the stability and strength of the chest wall is not compromised. “I’m very pleased with Patrick’s appearance,” said Flynn. “He looks really great. His chest looks very normal, and it is going to keep looking more natural as he grows.” University of Missouri Health Care’s system of hospitals, clinics and telehealth sites employs approximately 6,000 clinicians, scientists, educators and other health professionals. The system includes University Hospital and Clinics, Children’s Hospital, Columbia Regional Hospital, Ellis Fischel Cancer Center and University Physicians, all based in Columbia, Mo. The health system also includes a long-term acute care facility, Missouri Rehabilitation Center, in Mount Vernon, Mo. Academic affiliates of the health system include the University of Missouri-Columbia School of Medicine, Sinclair School of Nursing and School of Health Professions. Other affiliates of the health system include Rusk Rehabilitation Center in Columbia, Mo.; Capital Region Medical Center in Jefferson City, Mo.; and Cooper County Memorial Hospital in Boonville, Mo. |
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