Kevin N. Johnson, MD, Dawn E

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Presentation transcript:

Hybrid Technique for Repair of Recurrent Pectus Excavatum After Failed Open Repair Kevin N. Johnson, MD, Dawn E. Jaroszewski, MD, MennatAllah Ewais, MD, Jesse J. Lackey, CSFA, Lisa McMahon, MD, David M. Notrica, MD The Annals of Thoracic Surgery Volume 99, Issue 6, Pages 1936-1943 (June 2015) DOI: 10.1016/j.athoracsur.2015.02.078 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Computerized tomography shows areas of (A) extensive calcification along the costosternal junctions and (B) malunion at costosternal junctions after a prior open pectus excavatum repair. The Annals of Thoracic Surgery 2015 99, 1936-1943DOI: (10.1016/j.athoracsur.2015.02.078) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative photographs of 2 patients with (A, B) sites of fibrotic malunion after prior failed, open pectus excavatum repair. These areas are (A) debrided back until viable cartilage is identified, and (B) foreign materials are removed to prevent further fibrosis and reaction. The Annals of Thoracic Surgery 2015 99, 1936-1943DOI: (10.1016/j.athoracsur.2015.02.078) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Algorithm to our operative approach for recurrent open patients. (MIRPE = minimally invasive repair of pectus excavatum.) The Annals of Thoracic Surgery 2015 99, 1936-1943DOI: (10.1016/j.athoracsur.2015.02.078) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 A Rultract (Rultract Inc, Cleveland, OH) table-mounted retractor is used for attempting chest wall elevation at initiation of case and with revision of open repair during the hybrid reconstruction. The Annals of Thoracic Surgery 2015 99, 1936-1943DOI: (10.1016/j.athoracsur.2015.02.078) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Titanium plating and sternal support bars are used and shown in (A) intraoperative photographs and (B) postoperative chest roentgenogram after hybrid reconstruction. The Annals of Thoracic Surgery 2015 99, 1936-1943DOI: (10.1016/j.athoracsur.2015.02.078) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A, B) Biologic mesh is used to cover titanium plating when mobilized muscle flaps are inadequate to provide complete coverage. The Annals of Thoracic Surgery 2015 99, 1936-1943DOI: (10.1016/j.athoracsur.2015.02.078) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions