BACKGROUND: Pectus excavatum (PEX) is a depression of the sternum in relation to the costal cartilages. Clinical and objective measures for classifying the defect are rare and difficult to apply. The present study aimed to create an anthropometric index (AI) for PEX as a method for diagnosis and for preoperative and postoperative assessment by comparing it to the Haller index (HI) and to the lower vertebral index (LVI). METHODS: From December 2001 to February 2004, 2 groups of patients were studied at our institution: a) 30 patients with normal configuration of the thoracic cage, upon physical examination; b) 20 patients with PEX. The latter underwent surgery according to the Ravitch technique modified by Robicsek, and they were evaluated in the postoperative period. All patients were assessed by means of the AI (clinical), HI (tomographic), and LVI (radiographic) measures at the level of deepest deformity in the case of the PEX patients, and in the distal third of the sternum in the normal patients. The patients who had undergone surgery were once again measured between the 60th and the 80th postoperative days. RESULTS: There was a high correlation between the AI and the HI (80% P < .001) and between the AI and the LVI (79% P < .001). The accuracy of the 3 indices was similar, in that the following cut points were established: AI = 0.12, HI = 3.10, and LVI = 0.25. Upon analyzing the preoperative results, we verified that for the 3 indices, over 75% of the patients with pectus excavatum were above the cut points and were confirmed as having the defect. In the postoperative results, the value of the indices found below the cut point was considered within the normal standard, and this occurred in 100% for the AI, in over 50% for the HI, and in 50% for the LVI. CONCLUSIONS: The AI allowed adequate measurement of the defect, maintaining a) a high correlation with the HI and the LVI and a high accuracy, similar to the already acknowledged and published indices and b) an efficient comparison between the preoperative measurement and the postoperative results.

Pectus excavatum (PEX) is the most frequent congenital deformity of the anterior chest wall. Few studies have classified the degree of anatomical distortion in an objective manner. Our objective was to present two new clinical and original methods for evaluation of PEX deformity developed in our service (chest cyrtometry and anthropometric index) that are simple and easily applicable in the office. Twenty patients with PEX (submitted to the technique of Nuss) and forty normal chest patients were studied: all patients were evaluated by the same objective methods. Our results suggest that the objective clinical methods are more sensitive or precise than the radiological ones by measuring the deformity in a direct manner external to the chest.

A lesão por radioterapia produz cicatrizes e disfunção tecidual, que também requerem debridamento e reconstrução. Grandes ressecções de tumores da parede torácica, ressecções pulmonares ou de massas mediastinais, como também os defeitos criados por trauma podem necessitar de reconstrução.Sendo os defeitos adquiridos da parede torácica na maioria das vezes decorrentes de infecções, a base para correção desses defeitos, além de drenagem do pus, é levar tecidos bem vascularizados para essas regiões infectadas. Esses tecidos bem vascularizados vão preencher o espaço morto e permitir a chegada de leucócitos, anticorpos e antibióticos à região infectada.Empiema torácico primário Empiema torácico primário Empiema torácico primário Empiema torácico primário Empiema torácico primário Na fase crônica do empiema há formação de uma carapaça ao redor do pulmão que fica limitado pela cavidade empiemática. Muitas vezes para se tratar o empiema crônico é necessário fazer uma pleurostomia. A pleurostomia deixa um defeito na parede torácica que precisa ser corrigido, às vezes, com rotação de tecido vascularizado para esta região.Empiema torácico secundário a ressecção Empiema torácico secundário a ressecção Empiema torácico secundário a ressecção Empiema torácico secundário a ressecção Empiema torácico secundário a ressecção pulmonar pulmonar pulmonar pulmonar pulmonar O empiema torácico pós-ressecção pulmonar pode ocorrer precoce ou tardiamente. A literatura aponta que em aproximadamente 80% dos empiemas pós-ressecção pulmonar a cura pode ser obtida com procedimento de pleurostomia. . .. . Assim, quando se obtém a cura do processo de formação purulenta, é o momento para se fazer uma reconstrução da parede torácica com rotação muscular. Outras vezes, em alguns casos de ressecção pulmonar, há persistência de uma fístula bronco-pleural, e nesse caso quando esta fístula não se fecha pode ser necessário o reforço da sutura brônquica com rotação de músculos da parede torácica. Nesse caso, a função do retalho muscular é levar tecido bem vascularizado para a região da fístula e reforçar a sutura.Para se fechar o orifício da pleurostomia é necessário a rotação de um grande músculo para obliteração da cavidade empiemática. . .. . O músculo grande dorsal deve ser inicialmente dividido em duas "tiras", sendo uma delas utilizadas para obliteração desse espaço e a abordagem deve ser realizada por uma toracotomia póstero-lateral. Os músculos peitorais maior e menor podem ser usados no lugar do grande dorsal por já serem naturalmente individualizados 3 . Esterno infectado Esterno infectado Esterno infectado Esterno infectado Esterno infectadoInfecções do osso esterno se tornaram freqüen-tes após a introdução da esternotomia mediana para operações cardíacas. A osteomielite do osso esterno tem uma incidência ao redor de 1-2% após operações cardíacas, e tem processo de tratamento prolongado levando os pacientes a um sofrimento longo. Se o processo de osteomielite é mais localizado, ele se cura com debridamento e antibioticoterapia. Outras vezes o ...

Background: Pectus excavatum is characterized by concave growth of costal cartilage and depression of the lower sternum. Clinical means of classifying these malformations are few and difficult to apply. Objective:To devise clinical tools for quantifying the deformity and comparing preoperative and postoperative findings.Method: A total of 10 pectus excavatum patients who underwent surgery in which the modified Robicsek technique was used by the Thoracic Surgery Group of the Hospital das Clínicas of the University of São Paulo School of Medicine, were clinically and radiologically evaluated in the preoperative and postoperative periods. Ten control individuals, presenting no thoracic or radiological abnormalities, were submitted to identical evaluations. Deformities at the sternum notch level and at the point of maximum deformity were assessed using the anthropometric index and the Haller index.Results: Multivariate analysis of anthropometric index means revealed significant differences between preoperative and control values and between preoperative and postoperative values, as well as a nonsignificant difference between postoperative and control values. The same results were obtained when Haller index means were analyzed. A paired comparison of preoperative and postoperative means showed two distinct groups. An 86% canonical correlation was found between the anthropometric index and the Haller index. Conclusion:Patients with pectus excavatum can be quantitatively assessed in the preoperative and postoperative periods through the use of the anthropometric index, which allows objective, comparative evaluation of the results and is easily performed.

OBJECTIVES:To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities.METHODS:Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent).RESULTS:Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11–40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old.CONCLUSION:In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.