Reoperation for Severe Complex Chest Wall Deformities After Failed Pectus Excavatum Surgery

Medical History

The patient is a 20-year-old male who has had pectus excavatum since birth. Due to the severity of the deformity, he frequently suffered from colds and sometimes experienced noticeable respiratory discomfort during childhood. At the age of 5, he underwent the sternal turnover procedure (a highly invasive open surgery) to correct the deformity. However, the chest wall depression did not improve postoperatively. Instead, it progressed into severe complex chest wall deformities, rapidly leading to scoliosis. Subsequently, the deformities worsened as the patient aged. One year ago, the patient developed severe dyspnea, necessitating supplemental oxygen to alleviate symptoms.

Preoperative Examination

The anterior chest wall exhibited severe complex deformities, manifesting as an overall depression but protrusions at the sternal manubrium and xiphoid process. The lower portion of the chest wall showed an irregular, uneven surface. The heart was significantly compressed, with an oxygen saturation of only 75% without supplemental oxygen. Severe scoliosis was also present.

Surgical Overview

An incision was made along the midline surgical scar to fully expose the bony structures of the anterior chest wall. Comprehensive pre-shaping of the chest wall bony structures was performed to restore a near-normal morphology. Subsequently, the Wang procedure was carried out to completely correct the deformities. The surgery proceeded smoothly without complications and was completed in 2 hours. Postoperatively, the cardiac compression was fully relieved, and the chest wall appearance was largely restored to normal.