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Kevin N. Johnson, MD, Dawn E

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1 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 (June 2015) DOI: /j.athoracsur Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

2 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  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

3 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  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

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

5 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  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

6 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  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

7 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  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

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