Open-Repair Surgery for Pectus Excavatum to Preserve Internal Thoracic Artery (ITA)
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SURGICAL TECHNIQUES AND INNOVATIONS
Open-Repair Surgery for Pectus Excavatum to Preserve Internal Thoracic Artery (ITA) Shunsuke Watanabe 1,2
&
Fujio Hara 1 & Toshihiro Yasui 1 & Tomonori Tsuchiya 1 & Tatsuya Suzuki 1
Received: 15 May 2020 / Accepted: 29 September 2020 # Association of Surgeons of India 2020
Abstract Pectus excavatum has been performed using techniques such as sternum elevation and sternum reversal; however, the Nuss method is now widely used. The Nuss method is considered less invasive, but it requires a plate. We have performed open-repair surgery that can be completed at once without using a plate as a standard procedure. Conversely, the usefulness of the internal thoracic artery (ITA) in coronary artery bypass surgery and breast reconstruction has increased in recent years. Therefore, since 2017, we changed the surgical procedure to preserve the ITA; here, we mainly report on the surgical procedure. Five patients, four boys and one girl, were examined for in Haller index, operation time, blood loss, postoperative complications, and postoperative hospital stay. Among the five cases, before the change of surgical procedure, the operation time, blood loss, and hospitalization period postoperatively were not significantly different from those before the change. Bilateral ITA could be preserved except in one patient in whom one side was damaged and ligated during the operation. No postoperative complications were observed in all cases. It is possible to preserve the ITA, and we intend to perform additional studies to evaluate its long-term effectiveness. Keywords Internal thoracic artery (ITA) . Pectus excavatum . Pediatric
Introduction Various surgeries for pectus excavatum have been performed and primarily involve sternum elevation (Ravitch method [1]) and sternum reversal. Currently, the Nuss method [2] is widely used and considered less invasive but requires the use of a sternal plate. In this study, we used the costal cartilage bridge method to perform sternum elevation in a process that is completed in one time and without the use of a foreign body. Furthermore, our approach is capable of treating asymmetric cases and indicated for children aged 5–6 years. Alternatively, the use of internal thoracic artery (ITA) in coronary artery bypass surgery and breast reconstruction has increased recently. Therefore, in 2017, we decided to adopt this method, and subsequently changed the respective surgical * Shunsuke Watanabe [email protected] 1
Department of Pediatric Surgery, Fujita Health University, Toyoake, Aichi, Japan
2
Department of Pediatric Surgery, Fujita Ika Daigaku Byoin, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi Prefecture 470-1192, Japan
process to preserve the ITA. Here, we primarily report on the efficiency of this process before and after this change in the surgical procedure for pectus excavatum.
Patients and Methods Study Design This is a cohort study that was verified based on the medical records of patients who underwent surgery at Fujita Health University H
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