gms | German Medical Science

Background: In the absence of demonstrable functional impairment, pectus excavatum is merely a congenital deformity, albeit with a marked psychological impact. Many patients do not wish to undergo thoracic remodeling surgeries, such as the Ravitch or Nuss procedures, that are invasive and do not have clearly afford respiratory or cardiac improvement.

Methods: From 1993 to 2015, we designed 401 custom-made silicone implants to treatfunnel chests. Prior to 2007, implants were made from plaster molds of the chest. Beginning in 2007, 3D reconstructions were made from CT scans by computer-aided design CAD. We prospectively recorded all assessments, and follow-up data since1993. Pre- and post-operative photographs of two random groups of 50 patients were analyzed, in a blinded manner, by two surgeons independently. Intra- and postoperative complications, clinical outcomes, patient satisfaction and quality-of-life, were evaluated.

Results: One infection and three hematomas were recorded. Peri-prosthetic seroma was evident in all cases. Patients rated the cosmetic outcomes of CAD implants significantly higher than those of the earlier implants made using plaster molds (p=0.030). The surgeons found that malformations were better corrected in the CAD group (86%) than the plaster group (72%) (p=0.038). Patient satisfaction was higher in the former group (p=0.011). MOS-SF36 scores revealed significant improvements, both socially and emotionally.

Conclusions: Correction of pectus excavatum using a CAD silicone implant fulfilsesthetic and psychological demands. The technique is simple, reliable, and yields high quality results. In the medium term, the approach may render invasive techniques obsolete. These surgeries remains risky, and of doubtful functional utility.