Twelve intractable funnel chests in young adults were treated with revascul
arization of the turnover sternum. The sternum and costal composite tissue
were resected at the outskirt of the depressed area. Special attention was
paid to the dissection of the vascular pedicle at both sides of the interna
l mammary vessels. The recipient vessels at one side were left long, so wer
e the donor vessels at the other side. A segment of the rib at the exit of
the recipient internal mammary vessels had to be removed to accommodate the
vessels and to facilitate vascular anastomosis. Vascular anastomosis was a
ccomplished with loupes (Keeler, sixfold magnification) in five patients be
cause the direction of the vessels is vertically oriented. In four cases, a
rtery and vein grafts were taken from the other side of the internal mammar
y vessels not bound for vascular anastomosis for length discrepancy of the
vessels, while the remaining cases had direct vascular anastomosis without
vascular grafting. Revascularization of the turnover sternum was performed
successfully without vascular compromise, The patients all recovered well w
ith much improved physical condition. Only one patient sustained spontaneou
s pneumothorax 1 month after the operation. Postoperative three-dimensional
computed tomographic (CT) scan revealed increment of thoracic cage volume
for 9-17%. Follow-up CT scan 2 years later revealed even more improved thor
acic cage expansion. (C) 1999 Wiley-Liss, Inc.