Abstract
Surgical procedures for pectus excavatum (PE) repair, such as minimally invasive repair
of pectus excavatum or similar interventions (modified open videoendoscopically assisted
repair of pectus excavatum), for remodeling the anterior thoracic wall may finally
not always achieve sufficiently pleasing aesthetic results. Particularly in the asymmetric
and polymorphic cases, remnant deformities may still be present after any sophisticated
remodeling attempt. On the other hand, some cases despite optimal surgical management
develop mild recurrences with partial concavity or rib cartilage distortion shortly
after pectus-bar removal. Secondary treatment options then may include open access
surgery, resection, or reshaping of deformed and prominent costal cartilage. Residual
concave areas can be filled by autologous tissue, such as cartilage chips, liposhifting,
or implantation of customized alloplastics. To provide the best options for a variety
of primary or secondary postsurgical expressions of anterior wall deformities, any
physician dealing with PE corrections should be familiar with various shaping and
complementary reconstructive techniques or at least should have knowledge of such.
However, among treating surgeons, there is an awareness that no single method can
be applied for every kind of funnel chest deformity. Careful selection of appropriate
techniques, either as a single approach for the ordinary deformities or in conjunction
with ancillary procedures for the intricate cases, should be mandatory, based on the
heterogeneity of symptoms, severity, expectations, and surgical and technical resources.
A variety of such ancillary reconstructive procedures for PE repair are explained
and illustrated herewith.
Keywords
congenital - thoracic wall deformity - refinement - adjuvant remodeling - aesthetic
surgery
