The Institute of Chest Wall Surgery
The Fourth Surgery for A Patient with Secondary Asphyxiating Thoracic Dystrophy
Medical History
The patient is a 32-year-old male who has had a sunken anterior chest wall since childhood. At the age of 5, he was diagnosed with pectus excavatum and underwent a Ravitch procedure. However, the corrective effect was poor, and a significant depression remained after surgery. As he grew older, the depression in his chest wall became more severe. This issue intensified after he entered puberty, resulting in breathing discomfort following physical activities. At the age of 21, he underwent a second chest wall surgery, specifically, the Nuss procedure, which did not alleviate his deformity but actually exacerbated it. His chest wall developed severe, complex deformities and progressively narrowed, leading to secondary thoracic dystrophy. Both the patient and his family became extremely discouraged by the outcome of the surgery.
Later, he decided against further attempts to correct the deformed bone structure and instead opted for cosmetic surgery, hoping to improve the appearance of his chest wall with implants. However, this surgery also failed to meet his expectations. The aesthetic appearance of his chest did not improve, and as he aged, the thoracic cage continued to narrow, leading to complications such as limited mobility and breathing discomfort. Increasingly troubled by his physical and emotional distress, the patient is now contemplating another surgery to completely rid himself of the deformity.
Preoperative Examination
Multiple surgical scars are visible on the anterior and lateral chest wall. The thoracic cage exhibits notable abnormalities, with the upper region significantly narrowed and the lower region broader. Additionally, the manubrium of the sternum protrudes forward, while the body of the sternum appears sunken. Both costal arches also protrude noticeably forward. These abnormal bone structures are placing considerable pressure on the heart. The patient was eventually diagnosis with secondary asphyxiating thoracic dystrophy.
Surgical Overview
The surgery began with the removal of prosthetics from both sides of the chest wall. The chest wall was then expanded using MatrixRIBs, and the structures between the ribs were reconstructed. The operation finished with the Wenlin procedure to correct the forward protrusion of the costal arches. After 5 and a half hours, the surgery completed successfully without any complications. After the surgery, there was a significant increase in chest cavity volume, and the appearance of the chest largely returned to normal.
