Repair of pectus carinatum, carinatum/excavatum complex patients with doubly double bar technique
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Repair of pectus carinatum, carinatum/excavatum complex patients with doubly double bar technique In‑Hag Song1 · Seung Jin Lee1 · Seock Yeol Lee1 Received: 9 January 2020 / Accepted: 11 March 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Surgical correction is needed for patients with pectus carinatum who do not adapt to bracing therapy. We performed the doubly double bar technique for ten patients who did not adapt to bracing therapy for patients with pectus carinatum and/or carinatum/excavatum complex type. A complete correction was achieved for all patients, and there were no complications. Our initial experience suggests that the doubly double bar technique can be performed effectively for pectus carinatum and/ or carinatum/excavatum complex type patients. Keywords Pectus carinatum · Doubly double bar · Repair
Introduction
Technique
Surgical correction such as the Ravitch procedure or minimally invasive repair of pectus carinatum (MIRPC) is needed for patients with pectus carinatum or carinatum/ excavatum complex type (complex type) who fail or do not adapt well to bracing therapy [1, 2]. The Ravitch procedure shows a good result, but it is an invasive surgical procedure [3], and is difficult to achieve a sufficient correction effect with conventional MIRPC that simply compresses a protruding area with a pectus bar [4]. The doubly double bar technique that we introduced in this study is an effective surgical procedure that overcomes the limitations of these conventional surgical methods.
Doubly double bar technique was a surgical procedure of anterior chest wall remodeling by dual compression of double compression and complete fixation system bar (DCCF) system (so-called ‘double bar’) that we reported as a technique of correction of pectus excavatum [5] for patients with the pectus carinatum and/or complex type. We performed the operation on patients whose chest was not severely stiff when the protruding chest was pressed manually before the operation. In this way, we performed doubly double bar techniques on ten patients with pectus carinautm and/or complex type from July 2015 to January 2019. Their mean age was 15.7 ± 2.87 years (ranged 12–22 years). The age of the patients was one 12 years, three 14 years, two 15 years, two 16 years, one 19 years and 22 years. Operations were performed in similar to the DCCF system. However, unlike the correctional technique for patients with pectus excavatum, two correction planes existed for the correction of carinatum and/or complex type. The upper plane (sternal area) with protrusion area must be compressed and the lower plane (costal cartilage) with depression area must be elevated to be corrected (Fig. 1). The lower plane is the undesirable depression that occurs when compressing the upper plane. To effectively correct these two planes, the bending rate of the double bars inserted into each plane must be different. In other words, the double bar which compresses the protruding part of the upper plane should have a low bending ra
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