The Institute of Chest Wall Surgery
Surgery for A 16-year-old Patient with Severe and Rare Complex Chest Wall Deformities
Medical History
The patient is a 16-year-old male who has been diagnosed with pectus excavatum in childhood but experienced no discomfort in daily life. At the age of 15, he underwent Nuss procedure during which a bar was placed in his chest wall. However, the depression in his chest wall persisted after the surgery, and he even developed new severe deformities. As the deformities gradually worsened, the patient developed scoliosis, and his entire chest wall became completely distorted, eventually losing its basic shape. Later, the patient underwent another minimally invasive surgery for spontaneous pneumothorax, during which the surgeon ligated bilateral pulmonary bullae without treating the chest wall deformities. Ultimately, because of the severe deformities and breathing discomfort, the patient came to our hospital for treatment.
Preoperative Examination
The patient was diagnosed with severe complex chest wall deformities accompanied by scoliosis. The heart was severely compressed and shifted to the left thoracic cavity.
Surgical Overview
We developed a personalized surgical plan for the patient. The operation first involved making incisions along the surgical scars on both sides of the chest wall to remove the bar inserted during the Nuss procedure. Then, a larger incision was made at the central scar on the anterior chest wall to fully expose the bone structure located at concave and convex areas of the chest wall. It was found that there were severe adhesions between the chest wall structure and the pericardium, with the heart being compressed into the left chest cavity.
First, the adhesions were thoroughly released, and a portion of the protruding ribs and costal cartilage at the top of the protrusion was cut off. By lifting and pressing down, the chest wall was adjusted to its normal height. Second, three MatrixRIBs was used to replace the removed rib sections, and their curvature was carefully adjusted to closely resemble the normal curvature of the chest wall, thereby completing the reconstruction of the thoracic cage. Third, a bar was placed and flipped within the chest wall to elevate the most depressed part of the central chest wall. Lastly, two bars were placed on and secured to the bone surface of the lower half of the chest wall. The surgery achieved a satisfactory result, eliminating the deformities and restoring the chest wall to its normal shape.
