1. A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair 
Charles L Willekes, MD, Carl L Backer, MD, Constantine Mavroudis, MD 
The Annals of Thoracic Surgery 
Volume 67, Issue 2, Pages (February 1999)
DOI: /S (99)

2. Fig 1
(a) Incision is a vertical midline incision directly over the deformity. (b) Skin flaps are elevated bilaterally using skin hooks and electrocautery. (c) Pectoralis muscle flaps are elevated off the cartilages with electrocautery.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

3. Fig 2
Subperichondrial resection of deformed cartilages, usually cartilages 3, 4, 5, and 6. (a) Perichondrium is scored with electrocautery. (b) Freer elevator is used to dissect the perichondrium away from the cartilage. (c) The cartilage is sharply divided in the middle to facilitate removal. (d) Towel clip is used to grasp and remove cartilage.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

4. Fig 3
The perichondrial sheaths and intercostal muscle bundles are dissected free of the sternum bilaterally.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

5. Fig 4
(a) Chisel and hammer are used to resect an anterior triangular wedge of the sternum, preserving the posterior table. (b) The posterior table is fractured and angulated anteriorly without displacement.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

6. Fig 5
(a) A substernal bar is fixed to the ribs laterally and to the sternum. The anterior sternal wedge has been closed with two sutures. (b) The perichondrial sheaths are attached to the sternal edges with interrupted sutures.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

7. Fig 6
The repair is completed by suturing the pectoralis and rectus abdominis muscle flaps together in the midline. Closed suction drains are placed beneath the pectoralis flaps and beneath the skin flaps.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )