Ann Thorac Surg 2005;80:2419
© 2005 The Society of Thoracic Surgeons
Correspondence
Innovative Single-Stage Repair of Severe Asymmetric Pectus Excavatum Defects
Francis Robicsek, MD, PhD
Carolinas Heart Institute Carolinas Medical Center 1001 Blythe Charlotte, NC28203
(Email: tjohn{at}sanger-clinic.com).
To the Editor:
I read with interest the article by Karagounis and colleagues [1]. Our experience with pectus excavatum repair using Marlex-mesh (Davol Inc, Bard Cardiosurgery, Cranston, RI) support is in agreement with the authors' observations (ie, the method "produces immediate sternal stability and avoids the need of a second operation) [1]. Initially we applied this technique only to the most severe cases, and then it became our procedure of choice for most pectus excavatum repairs for the past 30 years [2, 3]. However, one asks why the authors restrict mesh support to asymmetrical deformities. Asymmetry has little to do with the need of posterior support and may be addressed by the uneven resection of the costal cartilages and correcting the sternal rotation with a figure-8 suture [2]. Also using strips of mesh instead of tailored sheath makes the repair unnecessarily cumbersome; however, it has the theoretical advantage that the intercostal structures remain in continuity.
Words of caution are as follows: (1) the retrosternal space so treated seemed apt to accumulate fluid. The easiest way to prevent this is to connect the retrosternal space with the right pleural cavity and insert a chest tube. This maneuver virtually provides ideal drainage and prevents wound complications. (2) The authors recommend that the costal cartilages be resected from "the costosternal joint to the osseous joint." Such a radical approach, especially in young children, may lead to cessation of growth of the anterior chest wall and acquired restrictive thoracic dystrophy, which is a disastrous situation. (3) The mobilized pectoralis muscles should be sutured together in front of the sternum; this will enhance healing, provide additional sternal stability, and it contours the chest wall [2].
The authors' valuable contribution confirms the virtues of Marlex-mesh sternal support.
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References
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- Karagounis V, Wasnick J, Gold J. An innovative single-stage repair of severe asymmetric pectus excavatum defects using substernal mesh bands Ann Thorac Surg 2004;78(e):19-21.
- Robicsek F. Surgical treatment of pectus excavatum. vol 2. Philadelphia: W.B. Saunders Company; 2000.
- Robicsek F. Marlex mesh support for the correction of very severe and recurrent pectus excavatum Ann Thorac Surg 1978;26:80-83.[Abstract]
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