Abstract
There has been a growing interest in the nonoperative treatment of chest wall deformities
over the last few decades; with the advent of external compressive orthotics, similar
outcomes have been reported compared with surgical intervention. There have been fewer
major complications reported with dynamic compression bracing on the chest wall; however,
the Achilles heel of this approach still lies with treatment tolerability and compliance.
A Medline literature search was undertaken to evaluate the evidence concerning the
techniques, modifications, and outcomes associated with external compressive bracing
in the setting of pectus carinatum. Sixteen articles were integrated after literature
review and data were collected on methods of assessing pectus carinatum (degree of
severity as well as type), patient selection protocol (i.e., suitability for external
compressive bracing), the bracing protocol itself, duration of treatment, metrics
used to assess outcome, and success, compliance, and dropout rate, and length of long-term
follow-up. Compressive external bracing appears to be a safe and well tolerated nonsurgical
treatment option for young patients with flexible pectus carinatum deformities. However,
there is still a need for robust level I randomized data from multiple centers with
a clearly standardized bracing protocol, objective measurement of outcomes, and recording
of results at the end of the bracing treatment program in sufficiently powered sample
sizes over a significant follow-up period.
Keywords
pectus carinatum - external compressive bracing - dynamic compression brace - Haller's
index
