Pectus Carinatum

15 yo boy with pectus carinatum deformity Seen previously at CHKD in Norfolk Patient repeatedly refused nonoperative management with brace Elected for operative intervention

Asymmetric, right sided costochondral deformity spanning cartilages 4-6 Basketweave-type interdigitating cartilages Protrusion ~ 2 cm to right of gladiolus

Pectus carinatum Incidence is 1:1000, 1:5000 for excavatum vs carinatum Carinate deformity occurs in families Male:female predominance 1.4 : 1 2 peaks of incidence (neonatal and teen) Keel chest – prominent gladiolus Pouter deformity – normal cartilage except those lateral to sternum

etiology Etiology unknown, parasternal cartilage derangement driven by genetics? Decreased collagen I stability Overgrowth of costal cartilage Displacement of sternum anteriorly

management Progressive sternal compression for 6 months Surgical repair if painful or cosmetic concerns Ravitch repair Ensure no additional genetic anomalies – Scoliosis – Marfan’s syndrome – Cardiac defects – Abnormal facies

Ravitch Subperichondral resection of offending cartilage pairs Separation of perichondrium from sternal edge Sternal remodeling and stabilization

technique Transverse incision Subcutaneous flap development Detach pectoralis and rectus from sternum Incise perichondrum Freer elevator to detach cartilage Perichondrum reapproximated Jackson-Pratt drain left

69 patients undergoing pectus repairs (both excavatum and carinatum) Patient satisfaction was primary outcome

results 7-10% seromas Pain in 3 patients No pneumothorax Minimal blood loss Conclusion: Ravitch repair is safe, effective and has high patient satisfaction