The Institute of Chest Wall Surgery
Revision Surgery for Nuss Procedure Failure
Medical History
The patient is a young male who has had pectus excavatum since childhood, with initial symptoms of a sunken chest and breathing difficulties. He has tried various conservative treatments, such as calcium and cod liver oil supplements, but none were effective.
As the patient grew older, the deformity became more severe, prompting him to seek treatment at several hospitals. Despite undergoing the Nuss procedure at one of the hospitals, the surgery failed to achieve a desired result, and the depression remained significant. Worse still, the deformity continued to deteriorate over time. To fully correct the deformity, the patient came to our hospital three years later for surgical treatment.
Preoperative Examination
The chest wall shows a significant, asymmetrical depression with severe heart compression. Additionally, one of the bars inserted during the Nuss procedure has shifted out of position.
Surgical Overview
Two incisions were made along the previous surgical scars on each side of the chest wall to expose and remove the two Nuss bars. An additional incision was made in the center of the chest, below the xiphoid process. The Wung procedure and the Wang procedure were then performed sequentially. The surgery was completed successfully with satisfactory results.
Related Photos
Our analysis indicates that the specific reasons for the failure of the patient's first surgery are as follow: (1) improper placement of the bars, which were not positioned at the bottom of the depression to provide adequate support; (2) unsuitable length and curvature of the bars; (3) flawed fixation, which resulted in one of the bars shifting out of position.
These issues not only prevented proper correction but also caused new deformities. Postoperative adhesions between the sternum and heart further increased the complexity and risk of re-operation. To improve safety of the second surgery, the Wang procedure and the Wung procedure were employed to ensure effective correction while minimizing the risk of complications.