A BETTER INCISION FOR PECTUS EXCAVATUM REPAIR - AVOIDING THE KELOID TRIANGLE

The most common approach to the repair of pectus excavatum and pectus carinatum deformities is via a central transverse submammary incision. The subsequent suprasternal scar is conspicuous and prone to hypertro phic and keloid scarring. To avoid the ''keloid triangle'' and to prod uce a less noticeable scar, we have utilized bilateral inframammary in cisions for repairs of five female and two male patients with pectus d efects. This approach provides excellent access for cartilage resectio n, sternotomy, and sternal support without increasing operative time o r compromising operative exposure. On follow-up for up to 25 months, a ll patients have had excellent cosmetic and functional results. Chest wall configuration and stability, wound healing, and scar formation ha ve all been without complication. No keloid or hypertrophic scars have developed. To date, there has been no recurrence of pectus defects. W e believe bilateral inframammary incisions are a superior approach for pectus repairs by enhancing cosmesis with less noticeable scars and f ewer hypertrophic and keloid scars, all without compromising operative exposure or increasing operative time.