THE SCIENCE OF
FIXING A BIRTH DEFECT

Total Single Stage Repair of Pectus
Excavatum Deformity

A 16-year-old male patient was brought to the BLK Centre for Plastic & Cosmetic Surgery with severe depression of the chest wall since birth, associated with difficulty in breathing during strenuous activities. The patient was diagnosed to have severe Pectus Excavatum with the Haller's Index of 3.8.

The patient underwent Single Stage Total Pectus Excavatum repair, a modification of the open Ravitch procedure. Bilateral inframammary incision was used and skin flaps were raised superiorly till clavicle and inferiorly upto costal margins followed by elevation of the pectoralis major muscle and rectus abdominis muscle flaps on both sides. After resection of the deformed cartilages on both the sides, substernal space was dissected. Wedge Osteotomy was performed in the superior part of sternum and deformity was fully corrected. Rigid fixation of the Osteotomy site of the sternum was performed using two titanium plates. Additional stability was provided to the corrected sternum by placing reconstruction plate anterior to the sternum and fixing it to rib and sternum using SS wires.

The patient was discharged on the seventh post-operative day in stable condition with fully corrected deformity. The patient and his parents were satisfied with the outcome of the procedure. Earlier, he was advised by multiple surgeons across countries that his deformity cannot be fully corrected at this age, and that he will need multistaged surgery. The patient's concern regarding the deformity was resolved finally after the correction procedure at BLK.

Pectus Excavatum is one of the very rare deformities in coloured races and quite uncommon in India. There is hardly any publication in literature from India. There are a variety of operative techniques described for the correction of Pectus Excavatum. The most popular being open Ravitch repair and its modifications. These are 2 stage procedures with associated complications of bar migration. For this particular patient, another modification (single staged) of Open Ravitch procedure was used which is not associated with the afore-mentioned serious complications.