The Institute of Chest Wall Surgery
The Surgery for A 59-year-old Patient with Severe Pectus Excavatum
Medical History
The patient is a 59-year-old male who has had a sunken chest since childhood, and the depression worsened gradually after adolescence. From the age of 30, he began experiencing chest tightness, which became more pronounced during vigorous activities. Three years ago, the patient underwent surgery to remove a cyst from his left lung, during which a rib from the left chest wall was removed, but no treatment was done for the pectus excavatum. Over the past two years, his symptoms have significantly worsened, leading to chest tightness, breathlessness, and difficulty breathing even at rest.
Preoperative Examination
The anterior chest wall exhibits an obvious depression, causing severe compression and displacement of the heart to the left thoracic cavity. The Haller index is notably high at 5.6.
Surgical Overview
During the surgery, a 2 cm incision was made on each side of the chest wall, followed by a third 2 cm incision below the xiphoid process. After thorough pre-shaping of the bone structure at the depression, two bars were inserted to correct the deformity. After the surgery, the deformity was completely resolved, and the chest wall returned to its normal appearance.
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The Necessity of Pre-shaping in Surgery for Elderly Patients with Chest Wall Deformity
In elderly patients, bones retain their strength but become more fragile compared to those of younger individuals. This fragility increases the risk of fractures under external forces, making it difficult to alter the bone shape. Therefore, the pre-shaping step during surgery is crucial, as it directly determines the desirability of the surgical outcome and significantly affects the risk of fractures.
Pre-shaping the depressed bone structure before inserting the bars effectively helps release local stress, thus significantly reducing the risk of fractures and other complications.This step not only lessens resistance in the subsequent bar shaping process but also ensures a smoother surgery, leading to a more ideal surgical outcome.