The Institute of Chest Wall Surgery
Minimally Invasive Surgery for A Young Female Patient with Flat Pectus Carinatum
Medical History
The young female patient has experienced a protruding chest wall since childhood, with the condition worsening during puberty. Initially, she sought treatment at a hospital and was misdiagnosed with pectus carinatum. Later, she went to another hospital where she was misdiagnosed with funnel chest and underwent the Nuss procedure. However, this surgery did not improve her condition. One year later, she came to our hospital to undergo surgery again, hoping to completely correct the deformity.
Preoperative Examination
The patient’s entire anterior chest wall is protruding forward, with a vertical groove-like depression in the center. There are old surgical scars visible on the lateral chest wall. The patient was clearly diagnosed with flat pectus carinatum.
Surgical Overview
The bar from the initial surgery was first removed, and a new one was inserted to perform the Wenlin procedure. Following this, the Wang procedure was done on the central part of the bar to lift the bone structure in the depressed area. The surgery was successful, and the deformity was corrected, restoring the normal appearance of the chest wall.
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The Speciality of Flat Pectus Carinatum
To distinguish this deformity from pectus carinatum, Dr. Wenlin Wang named it flat pectus carinatum. This condition manifests as an overall forward protrusion of the chest wall, accompanied by a localized depression in the center. Therefore, it is a special complex chest wall deformity.
The surgical treatment of flat pectus carinatum is complicated by localized depression. If this deformity is mistaken treated as pectus carinatum, focusing only on correcting the protrusion without addressing the central depression, the surgical result will not be satisfactory. On the other hand, treating this condition as pectus excavatum and using the standard Nuss procedure to correct the depression can also lead to poor results. This ineffectiveness arises from the excessive rigidity and concentrated stress in the depressed area of the bone, along with the lack of a suitable support point for inverting the bar.
To better correct flat pectus carinatum, it is not only crucial to adopt specific techniques for both the protrusion and the depression, but also to incorporate the concept of pre-shaping into the surgical procedure. In this operation, we combine the Wenlin procedure and the Wang procedure to simultaneously correct both the depression and the protrusion.