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Thorac Cardiovasc Surg 2016; 64(01): 062-069
DOI: 10.1055/s-0035-1552924
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Scoring of Deformed Costal Cartilages Reduces Postoperative Pain after Nuss Procedure for Pectus Excavatum

Tomohisa Nagasao
1   Department of Plastic Surgery, Kagawa University, Takamastu, Kagawa, Japan
,
Yusuke Hamamoto
1   Department of Plastic Surgery, Kagawa University, Takamastu, Kagawa, Japan
,
Motoki Tamai
1   Department of Plastic Surgery, Kagawa University, Takamastu, Kagawa, Japan
,
Tetsukuni Kogure
1   Department of Plastic Surgery, Kagawa University, Takamastu, Kagawa, Japan
,
Hua Jiang
2   Department of Plastic Surgery, Shanghai Second Military Medical College, Changzheng Hospital, Shanghai, China
,
Naoki Takano
3   Department of Mechanical Engineering, Keio University, Yokohama, Kanagawa, Japan
,
Yoshio Tanaka
1   Department of Plastic Surgery, Kagawa University, Takamastu, Kagawa, Japan
› Author Affiliations
Further Information

Publication History

25 September 2014

12 March 2015

Publication Date:
10 July 2015 (online)

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Abstract

Objective The present study aims to elucidate whether or not scoring deformed cartilages reduces postoperative pain after the Nuss procedure for pectus excavatum patients.

Methods A total of 46 pectus excavatum patients for whom the Nuss procedure was conducted were included in the study. The patients were categorized into two groups, depending on whether or not the supplementary maneuver of scoring deformed cartilages was performed in addition to the Nuss procedure. Patients for whom deformed costal cartilages were scored were categorized as the Scoring Group (n = 24); those who received no such scoring were categorized as the Non-Scoring Group (n = 22). After evaluating the maximum stresses occurring on the thoraces by means of dynamic simulation using finite element analyses, intergroup comparison of the maximum von-Mises stress values was performed. Furthermore, after quantifying postoperative pain as the frequency with which patients injected anesthetics through an epidural pain-control system within 2 postoperative days, the degree of pain was compared between the two groups.

Results The maximum stresses occurring on the thorax were significantly greater for the Non-Scoring Group than for the Scoring Group; injection frequency was also greater for the Non-Scoring Group (average 4.9 times for 2 days) than for the Scoring Group (average 2.5 times for 2 days).

Conclusion High stresses occur due to the performance of the Nuss procedure, causing postoperative pain. The stresses can be reduced by performing supplementary scoring on deformed cartilages. Accordingly, postoperative pain is reduced.

Keywords

chest - treatment - anesthesia
 

  • References

  • 1 Kelly Jr RE, Lawson ML, Paidas CN, Hruban RH. Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival. J Pediatr Surg 2005; 40 (8) 1275-1278
    CrossrefPubMedGoogle Scholar
  • 2 Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (4) 545-552
    CrossrefPubMedGoogle Scholar
  • 3 Hebra A, Swoveland B, Egbert M , et al. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 2000; 35 (2) 252-257 , discussion 257–258
    CrossrefPubMedGoogle Scholar
  • 4 Coln D, Gunning T, Ramsay M, Swygert T, Vera R. Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. World J Surg 2002; 26 (10) 1217-1221
    CrossrefPubMedGoogle Scholar
  • 5 Croitoru DP, Kelly Jr RE, Goretsky MJ, Gustin T, Keever R, Nuss D. The minimally invasive Nuss technique for recurrent or failed pectus excavatum repair in 50 patients. J Pediatr Surg 2005; 40 (1) 181-186 , discussion 186–187
    CrossrefPubMedGoogle Scholar
  • 6 Boehm RA, Muensterer OJ, Till H. Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children. Plast Reconstr Surg 2004; 114 (3) 668-673 , discussion 674–675
    CrossrefPubMedGoogle Scholar
  • 7 Hanna WC, Ko MA, Blitz M, Shargall Y, Compeau CG. Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction. Ann Thorac Surg 2013; 96 (3) 1033-1036 , discussion 1037–1038
    CrossrefPubMedGoogle Scholar
  • 8 Kopperdahl DL, Pearlman JL, Keaveny TM. Biomechanical consequences of an isolated overload on the human vertebral body. J Orthop Res 2000; 18 (5) 685-690
    CrossrefPubMedGoogle Scholar
  • 9 Yamada H, Evans FG. Material properties of organs. In: Yamada H, Evans FG, eds. Strength of Biological Materials. Baltimore, MD: Williams & Wilkins; 1970: 297
    Google Scholar
  • 10 Nagasao T, Miyamoto J, Tamaki T , et al. Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in different patterns between adult and child patients. J Thorac Cardiovasc Surg 2007; 134 (6) 1502-1507
    CrossrefPubMedGoogle Scholar
  • 11 Nagaso T, Miyamoto J, Kokaji K , et al. Double-bar application decreases postoperative pain after the Nuss procedure. J Thorac Cardiovasc Surg 2010; 140 (1) 39-44 , 44.e1–44.e2
    CrossrefPubMedGoogle Scholar
  • 12 Nagasao T, Miyamoto J, Ichihara K, Jiang H, Jin H, Tamaki T. Age-related change of postoperative pain location after Nuss procedure for pectus excavatum. Eur J Cardiothorac Surg 2010; 38 (2) 203-208
    CrossrefPubMedGoogle Scholar
  • 13 Nagasao T, Noguchi M, Miyamoto J , et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg 2010; 140 (6) 1294-9.e1
    CrossrefPubMedGoogle Scholar
  • 14 Johnson WR, Fedor D, Singhal S. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg 2014; 9: 25
    CrossrefPubMedGoogle Scholar
  • 15 Zienkiewicz OC, Taylor RL, Zhu JZ. The Finite Element Method: Its Basis and Fundamentals, 6th ed. Oxford: Butterworth-Heinemann; 2005: 752p
    Google Scholar
  • 16 Sarrafpour B, Swain M, Li Q, Zoellner H. Tooth eruption results from bone remodelling driven by bite forces sensed by soft tissue dental follicles: a finite element analysis. PLoS ONE 2013; 8 (3) e58803
    CrossrefPubMedGoogle Scholar
  • 17 Li P, Shen L, Li J, Liang R, Tian W, Tang W. Optimal design of an individual endoprosthesis for the reconstruction of extensive mandibular defects with finite element analysis. J Craniomaxillofac Surg 2014; 42 (1) 73-78
    CrossrefPubMedGoogle Scholar
  • 18 Pintar FA, Philippens MM, Zhang J, Yoganandan N. Methodology to determine skull bone and brain responses from ballistic helmet-to-head contact loading using experiments and finite element analysis. Med Eng Phys 2013; 35 (11) 1682-1687
    CrossrefPubMedGoogle Scholar
  • 19 Chen Z, Pan X, Shao Q, Chen Z. Biomechanical effects on maxillary protraction of the craniofacial skeleton with cleft lip and palate after alveolar bone graft. J Craniofac Surg 2013; 24 (2) 446-453
    CrossrefPubMedGoogle Scholar
  • 20 Wang M, Qu X, Cao M, Wang D, Zhang C. Biomechanical three-dimensional finite element analysis of prostheses retained with/without zygoma implants in maxillectomy patients. J Biomech 2013; 46 (6) 1155-1161
    CrossrefPubMedGoogle Scholar
  • 21 Iivarinen JT, Korhonen RK, Julkunen P, Jurvelin JS. Experimental and computational analysis of soft tissue mechanical response under negative pressure in forearm. Skin Res Technol 2013; 19 (1) e356-e365
    CrossrefPubMedGoogle Scholar
  • 22 Chang PY, Hsu ZY, Chen DP, Lai JY, Wang CJ. Preliminary analysis of the forces on the thoracic cage of patients with pectus excavatum after the Nuss procedure. Clin Biomech (Bristol, Avon) 2008; 23 (7) 881-885
    CrossrefPubMedGoogle Scholar
  • 23 Davison SP, Sobanko JF, Clemens MW. Use of a collagen-glycosaminoglycan copolymer (Integra) in combination with adjuvant treatments for reconstruction of severe chest keloids. J Drugs Dermatol 2010; 9 (5) 542-548
    PubMedGoogle Scholar
  • 24 Nagasao T, Aramaki-Hattori N, Shimizu Y, Yoshitatsu S, Takano N, Kishi K. Transformation of keloids is determined by stress occurrence patterns on peri-keloid regions in response to body movement. Med Hypotheses 2013; 81 (1) 136-141
    CrossrefPubMedGoogle Scholar
  • 25 Robicsek F. Repair of pectus excavatum. Ann Thorac Surg 2010; 90 (1) 363
    PubMedGoogle Scholar
  • 26 Robicsek F, Watts LT. Surgical correction of pectus excavatum. How did we get here? Where are we going?. Thorac Cardiovasc Surg 2011; 59 (1) 5-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Hamaji M, Hiraoka K, Jaroszewski DE, Deschamps C. Modified Robicsek procedure for pectus excavatum in adult patients. Interact Cardiovasc Thorac Surg 2014; 18 (5) 611-614
    CrossrefPubMedGoogle Scholar