The Institute of Chest Wall Surgery
Re-operation for A 30 year-old Patient with Grooved Chest
Medical History
The patient, a 30-year-old male, was diagnosed with pectus excavatum five years ago and underwent the Nuss procedure. However, the patient was greatly disappointed as there was no noticeable change in the appearance of his chest wall after the surgery. Three years later, the patient had the Nuss bar removed. Disillusioned by his unsuccessful surgery, he had no intention of undergoing another operation. However, starting from the fourth year after the surgery, the depression in his chest wall became increasingly pronounced, causing him frequent and significant breathing discomfort. In order to completely correct the deformity and eliminate the symptoms, the patient came to our hospital for a second surgery.
Preoperative Examination
There are three old surgical scars on the lateral chest wall—two on the right and one on the left. A horizontal groove-like depression is present at the lower part of the anterior chest wall near the xiphoid process, accompanied by noticeable heart compression and forward protrusion of the costal arch. The patient was ultimately diagnosed with grooved chest.
Surgical Overview
The Wang procedure was performed during surgery to correct the deformity. The operation was completed in 1 hour and achieved a satisfactory result, eliminating the chest wall deformity effectively.
Related Photos
The Difference Between Grooved Chest and Pectus Excavatum
Although both grooved chest and Pectus Excavatum (PE) are deformities that manifest as depressions in the anterior chest wall, they have clear differences. Visually, the depression in PE typically appears bowl-shaped or dish-shaped, and when the depression is severe and localized, the deformity can even resemble a cup shape. In contrast, the depression in grooved chest is a horizontal groove-like depression located in the lower part of the chest wall. Unlike PE, this depression is relatively flat, and there is no significant height difference between the interior and the edges of the depression.
The Nuss procedure is suitable for treating PE because the depression is surrounded by relatively protruding edges that provide suitable fulcrums. However, the depression of grooved chest lacks these edges, making it challenging for the Nuss procedure to effectively correct them.
To ensure satisfactory correction results, the surgical procedure for grooved chest requires a personalized design, and one of the most common procedures is the modified Wang procedure.