A new method of reconstruction for pectus excavatum that preserves blood supply and costal cartilage

We began in 1982 to use a modified Ravitch procedure that preserves the blo od supply to the sternum to correct funnel chest deformities, but there wer e some problems such as postoperative paradoxical respiration, chest wall i rregularity, and palpable heart beat. To resolve these problems, the concep t of Jensen's procedure was incorporated into the authors' previous method. In Jensen's method, only a small portion of the deformed cartilages is rese cted, and almost all of them are preserved. A preformed stainless steel str ut is used for chest wall stabilization. The authors preserved the costal c artilages in a manner similar to Jensen's, but the anterior chest wall was stabilized With miniplates and Kirschner wires instead of a large retroster nal strut. The xiphoid process with the lower end of the sternum was detach ed and moved cephalad. None of the patients developed respiratory failure post operatively. Althou gh the follow-up periods were short, satisfactory results were obtained wit h no recurrence of the deformities. The main advantages of our procedure are (1) basic blood supply to the ches t wall is preserved, (2) stability of corrected chest wall is maintained wi th miniplates and Kirschner wires without a large metallic strut, and (3) p reserved costal cartilages make the chest wall rigid and the incidence of r espiratory failure low. We conclude that this method is simple and produces satisfactory results with a rigid chest wall.