TREATMENT OPTIONS
3D Custom-Made Implant (Pectus Excavatum & Poland Syndrome)
Modern computer-assisted reconstruction techniques for implants have increased the aesthetical surgical results for patients with either Pectus Excavatum or Poland Syndrome as each 3D implant is unique, custom-made and individually designed for each patient.
Front Views
Bottom Views
All reconstruction implants are designed by AnatomikModeling and manufactured by their partner Sebbin. The implant is made from a medical grade rubber silicone elastomer. This material is a foreign body however, there is no immune ‘rejection’ reaction. There is no risk of tearing, perforation or rupture and never any fibrous retraction (shell) in the long term (for life).
Professor Karen Redmond demonstrates how the custom-made 3D implant fills the ‘hole’ in a minimally invasive way, perfectly matching the shape of the rib cage for 38 year old Pectus Excavatum patient with previous failed Ravitch surgery repair, Haller Index 3.5.
For Pectus Excavatum the 3D implant fills the ‘hole’ in a minimally invasive way, perfectly matching the shape of the rib cage.
For Poland Syndrome the 3D implant replaces the missing pectoralis muscle to get the best possible symmetry with the opposite muscle.
Specialist Screening Healthcare Ireland’s Clinical Director, Professor Karen Redmond is the first and only consultant thoracic surgeon offering the AnatomikModeling 3D custom-made implant in Ireland. PectusCheck is able to offer access and education to the latest innovation diagnostic and treatment options best suitable to your chest wall deformity.
3D Custom-Made Implant Surgery for Pectus Excavatum & Poland Syndrome Key Summary Points
Requires one surgery performed under general anaesthesia and lasts on average 1 hour and presents minimal risks with immediate results.
New Innovative minimally invasive surgical technique compared to traditional methods such as the Modified Ravitch Procedure.
CT Chest High Resolution non-contrast required. Slice thickness 1mm to 1.2mm. Standard DICOM file format.
From design to manufacturing process the 3D reconstruction implant delivery timeline is up to a 16 week process.
Hospitalisation stay is 3 days maximum, sick leave for 15 days and sports restriction for 3 months.
Follow up consultation after 8 days with possible puncture of seroma. Fluid can collect around the scar called a seroma. This is drained both in hospital and at follow-up outpatient clinic appointments with your consultant. There are no drains placed at surgery to minimise scarring and infection risks. One month for the oedema (build-up of fluid which causes swelling) to resolve and then 1 year for the scar to fade.
A post-surgical thoracic compression vest must be worn night and day for 1 month.
Lifelong implant that is MRI compatible.
Jogging/running can begin after 1 month but 3 months for weightlifting and other exercises involving traction on pectoralis muscles such as body building and push up etc… This is due to the high risk of muscle suture rupture before 3 months.
Compression vest must be worn for 1 month 24/7.
Nuss Surgery for Pectus Excavatum
The minimally invasive Nuss procedure is performed using video-assisted thorascopic surgery (VATS). A tiny camera is inserted into the chest to guide the procedure, two small incisions are made on either side of the chest, and one or two curved steel bars (Pectus support bar) is inserted under the sternum or breastbone. Drains are then inserted on one or both sides of the chest to remove any fluid from the surgical site. Individually curved for each patient, the Pectus support bar is used to correct the depression and is secured to the chest wall on each side.
Nuss Procedure for Pectus Excavatum Key Summary Points
In adults, the pectus bar is left in place for 3 to 5 years. Some patients prefer to keep the bar permanently as it reduces the risk that their pectus anomaly will come back.
More invasive surgery so risks including bleeding, infection, bar displacement are higher.
Hospitalisation stay is usually 5 days.
No lifting, carrying, pushing or pulling for 2 months. Avoid carrying backpacks for 3 months. No contact or high velocity sports such as karate, snowboarding, gymnastics, hockey, etc. for 3 months. Avoid twisting and bending of the back for 3 months. You can bend at the hips only.
Risk associated with this surgery is a potential metal sensitivity reaction or allergic reaction to the implant (Pectus support bar) material (metal). You are not a candidate for treatment with the Pectus support bar if you have certain metal allergy or sensitivity.
A second surgery to remove the bar is required. After having the pectus bar removed, patients typically need 1 to 2 weeks off school or work.
To note, the pectus bar is MRI conditional meaning the settings of an MRI scanner need to be changed to specific settings as per the manufacture guidelines of the Pectus bar in order to undergo an MRI of the chest safely. It is recommended to have a CT scan whilst the pectus bar is in place. MRI’s are acceptable for other areas of the body such as head, knee, etc.
Post Operative Care Following NUSS Procedure – Patient Information Sheet
PectusUp or Taulinoplasty Surgery (Pectus Excavatum)
Taulinoplasty also referred to as PectusUp, uses a plate-like implant or prosthesis and a sternal tractor screw. Together, they assist in raising the sternum to place it in the desired position and keep it there. It is a new minimally invasive surgery intervention that, compared to Nuss or Ravitch, will require less surgical and anaesthetic time, less need for analgesia and fewer days of admission. PectusUp allows the elevation of the sternum without the need to insert steel bars into the thoracic cavity or to remove part of the ribs in order to reduce the sinking of the sternum or breastbone.
The implant used for this type of treatment is the PectusUp Kit, developed by Ventura Medical Technologies, offering a minimally invasive solution for the treatment of Pectus Excavatum. PectusUp consists of placing an implant on top of the sternum, through a small incision in the chest, which pulls it up to achieve a more anatomically correct position. Subsequently, the implant is fixed to the sternum and the costal cartilages to maintain this position after the intervention.
In February 2020, Specialist Screening Healthcare Ireland’s Clinical Director, Professor Karen Redmond carried out the first minimally invasive PectusUp procedure for Pectus Excavatum in the British Isles at The Mater Misericordiae University Hospital.
Pectus UP Surgery for Pectus Excavatum Key Summary Points
As it is an extrathoracic (outside the chest) procedure, pain is greatly reduced, entails a shorter recovery period and is free of serious complications compared to traditional open techniques like the Ravitch or NUSS.
Hospitalisation stay is 2-3 days maximum.
The rest period is about 1 week after the operation. Relative rest of 1 month is strongly recommended.
It is advisable to sleep on your back and avoid lying on your side during sleep (at least for the first 3 months).
Avoid all contact sports. Generally, start back at sport activities 6 months after the operation, pending thoracic surgeon’s approval.
Refrain from high-contact sports or those that involve torso movement such as golf, swimming tennis, etc. for a period of one year.
Failure to comply with postoperative instructions may lead to complications such as the PectusUp implant becoming loose, move or dislodged if it is subjected to weight bearing, loads or very intense activities, or if the patient suffers traumatic injuries to the thorax.
Reactions due to sensitivity to metals or allergic reaction to implant material can occur.
The implant is removed 3 to 4 years after surgery or at the time the chest has reached the desired shape. Withdrawal is very simple and is usually performed without the need for over-night hospitalisation.
The number of cases performed globally are small so long-term outcomes have not yet been described.
Useful option for patients that are still growing.
Post Operative Care After PectusUp Surgery
Open Invasive Treatment Option for Pectus Excavatum & Pectus Carinatum
Modified Ravitch Procedure (Pectus Excavatum & Pectus Carinatum)
The Ravitch procedure for Pectus Excavatum and Pectus Carinatum is not widely practised as it is a more extensive open and invasive operation technique. It can be helpful in certain clinical situations:
- In older patients, where the sternum has calcified.
- Severe asymmetrical deformity.
- Failure of more minimally invasive techniques.
- Failure of bracing systems in complex rib deformities and pectus carinatum.
Ravitch Procedure for Pectus Excavatum & Pectus Carinatum – Key Surgery Summary Points
The Ravitch procedure is performed under general anaesthesia. The procedure takes about 90 min.
In the modified Ravitch procedure, the rib cartilages are cut away on each side and the sternum is flattened so that it will lie flat. One or more bars (or struts) may than be inserted under the sternum to ensure it keeps it shape.
If a patient is being treated for Pectus Excavatum, a small bar is inserted under the sternum to hold it in the desired position.
The extent of the operation depends upon the severity of the patient’s condition. The cartilage will regenerate over the next 4 to 6 weeks, fixing the sternum in position. A small drain may be placed at the operation site to prevent a fluid collection or lung collapsing.
Hospitalisation for 5 to 7 days. The length of hospitalization is mainly determined by pain management.
For patients treated for Pectus Excavatum, the bar is removed approximately six months after the procedure.
Usually, it takes 6 months or more for a patient to return to all activities they did before the surgery. For approximately six weeks after the surgery, the patient should take all medicines as prescribed by the surgeon.
Sternal non-union or lack of cartilaginous regrowth may occur.
Non-Surgical Bracing Treatment Options for (Pectus Carinatum & Rib Flare)
PectusCheck Customised Bracing Programme (Pectus Carinatum & Rib Flare)
Compressive bracing systems, results in a significant improvement in Pectus Carinatum appearance in patients with an immature skeleton. The custom-made design of the T-Joe Bracing System allows for improvement of mild Pectus Carinatum defects to the most severe asymmetric carinatum deformities. Patient compliance in wearing the brace, adhering to a customised exercise programme facilitated by our consultant specialist together with diligent follow-up appear to be paramount for the success of this method of treatment and has made it possible to avoid surgical complications. For these reasons, A bracing system is considered the first line of treatment for pectus carinatum or pigeon chest and is the preferred method to reshape the chest wall. Surgical treatment such as the Modified Ravitich Procedure is used as a second-line treatment in patients who were noncompliant to the brace treatment.
The T-Joe Pectus Bracing System offers a custom design with 3D scanning software and is manufactured in the United States. It is the leading brace system used by physicians worldwide.
Using an attached Structure Sensor and ipad, Specialist Screening Healthcare Ireland’s PectusCheck services takes a 3-D Scan of your pectus chest deformity along with photos using the connected ipad. T-Scan software precisely measures and analyses the chest deformity to aid in the fabrication of a fully customized T-Joe Pectus Brace. 3D Scanning is safe with no harmful radiation. Additional scans are taken during treatment to monitor progress and improvement during treatment
Pectus Excavatum patients can often have ‘flared ribs’ or costal arch inversion, the T-Joe Bracing System offers a version of the brace for rib flare deformities where the lower ribcage sticks out and frequently goes along with both Carinatum and Excavatum chest wall defects.
T- Joe Pectus Bracing System for Pectus Carinatum & Rib Flare Conditions Key Summary Points
Due to its sleek mechanical design the T-Joe brace has the flattest profile of any Pectus brace, making it comfortable to wear and barely visible under clothing. The female version of the brace is more hourglass in shape.
The anatomically friendly shape of the brace allows for unrestricted arm motion and can even be worn during physical activities, such as sports team practices, and gym class.
Using an attached Structure Sensor and ipad it takes a 3-D Scan of a pectus chest deformity along with photos using the connected ipad. T-Scan software precisely measures and analyzes the chest deformity to aid in the fabrication of a fully customized T-Joe Pectus brace. 3D Scanning is safe with no harmful radiation. Additional scans are taken during treatment to monitor progress and improvement during treatment.
The T-Joe bracing system is customized to each person ensuring comfortable fit, and the best correction to the Pectus defect.
The Pectus bracing program lasts around 8 to 12 months, and we recommend that we see you 2 to 3 times after the first consultation to assess progress, adjust the brace fitting and give advice around reducing the amount of time the brace is worn. Patients, depending on their needs as part of our follow-up Pectus program will also go through a customized exercise and physical therapy assessment, evaluation and training program.
Assessment includes pressure measurement of chest wall flexibility.
Fitting of brace includes ‘manipulation’ (correction) of ‘pigeon chest’ and custom brace fitting with adjustments.
For first 8 weeks brace is worn permanently (off for washing only).
After 8 weeks brace is removed for 1-2 hours each day.
After 12 weeks brace is removed increasingly each day.
By 24 weeks the brace is worn 12 hours a day only.
By week 32 the brace is worn for maintenance only.
The brace program finishes after week 40.
