Minimally Invasive Repair of Pectus Carinatum

Pectus carinatum can be corrected by a number of surgical and non-surgical techniques

Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection

Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall

The procedure requires Zimmer Biome pectus tray containing tunnelers and bars, plus 4 hole stabilizers, bendable rib protectors, and pioneer sternal cable system

The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia

Prophylactic antibiotics are given and a Foley catheter is inserted and kept for 24 hours

Bar length is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction

The bar ends should correspond to the intercostal space between the two ribs where the stabilizers will be anchored

Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters

A 1 inch periosteal incision is made in the rib and the periosteum separated from the underlying bone anteriorly and posteriorly

A rib protector of similar size to the measured subperiosteal space is bent to the shape of the rib and a cable is threaded through its holes

The cable and protector are passed under the rib within the subperiosteal space

A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years

A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint

Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position

The bar is tightly anchored to 4 ribs, 2 on each side

The rib protectors prevent the cables from cutting through the ribs

One year after repair, excellent correction was achieved and maintained

In addition to correction of the pectus, lateral chest wall expansion occurred