Ann Thorac Surg 2001;71:760-761
© 2001 The Society of Thoracic Surgeons
Correspondence
Steel strut fracture after pectus excavatum operation: a technical problem?
Guglielmo M. Actis Dato, MDa,
Enrico Ruffini, MDa
a Italian Institution of Cardiac Surgery, Piazza de Amicis 121 bis 10126, Torino, Italy
e-mail: actisdato{at}hotmail.com
To the Editor
We read with interest the paper of Onursal and colleagues reporting a case of steel strut rupture after surgical correction of pectus excavatum in a 18-year-old patient [1]. We have been employing a similar technique for the correction of this chest wall deformity since 1958 using an original steel strut moulded in the shape of seagull wings [2]. The prosthesis is made according to specific requirements of resistance, compatibility, and pliability. In particular, the steel struts we use are cut from a large plate of AISI 316 steel. The thickness ranges from 2.5 to 3.0 mm, and the size varies from 14 to 35 cm in length and 11 to 13 mm in width. In addition, every prosthesis undergoes a process of hand sanding and barrel polishing (Fig 1) to smooth surface edges. We recently reviewed [3] our series of 357 patients (mean age 18 ± 5 years) operated on with this technique and we did not have any case of strut fracture even in the case of late removal of the prosthesis.
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Fig 1. The steel strut moulded in the shape of seagull wings before the positioning under the sternum for pectus excavatum repair according to our technique.
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In our opinion, the steel strut used by Dr Onursal looks rather thin (1.0 to 1.8 mm) and small (6 to 10 mm wide). Moreover, the hardness of the steel is not reported by the authors; a theoretical explanation of the complication described by the authors might indeed have been a too hard composition of the steel used in the production of the strut from the technical department of their hospital. It would be interesting to know the exact steel composition and the processing of the prosthesis used by the authors.
In conclusion, we believe that the use of retrosternal steel strut after sternal and costal cartilage resections for pectus excavatum repair represents a valuable therapeutic approach in order to obtain optimal fixation of the chest wall. The prosthesis in our experience should be removed between 6 and 12 months after the implant; earlier removal exposes to the risk of recurrence. Finally, appropriate materials should be employed to avoid potentially lethal complications, such as that reported by the authors.
References
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Onursal E., Toker A., Bostanci K., Alpagut U., Tireli E. A complication of pectus excavatum operation: endomyocardial steel strut. Ann Thorac Surg 1999;68:1082-1083.[Abstract/Free Full Text]
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Actis Dato G.M., De Paulis R., Actis Dato A., et al. Correction of pectus excavatum with a self-retaining seagull wing prosthesis. Long-term follow-up. Chest 1995;107:303-306.[Abstract/Free Full Text]
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Actis Dato G.M., Cavaglià M., Ruffini E., et al. The seagull wing self-retaining prosthesis in the surgical treatment of pectus excavatum. J Cardiovasc Surg 1999;40:139-146.[Medline]
