Brace Compression for Treatment of Pectus Carinatum

Abstract

BackgroundSurgery has been the classical treatment of pectus carinatum (PC), though compressive orthotic braces have shown successful results in recent years. We propose a non-operative approach using a lightweight, patient-controlled dynamic chest-bracing device.Materials and MethodsEighteen patients with PC were treated between July 2008 and June 2009. The treatment involved fitting of the brace, which was worn for at least 20 hours per day for 6 months. Their degree of satisfaction (1, no correction; 4, remarkable correction) was measured at 12 months after the initiation of the treatment.ResultsThirteen (72.2%) patients completed the treatment (mean time, 4.9±1.4 months). In patients who completed the treatment, the mean overall satisfaction score was 3.73±0.39. The mean satisfaction score was 4, and there was no recurrence of pectus carinatum in patients who underwent the treatment for at least 6 months. Minimal recurrence of pectus carinatum after removal of the compressive brace occurred in 5 (38.5%) patients who stopped wearing the compressive brace at 4 months.ConclusionCompressive bracing results in a significant improvement in PC appearance in patients with an immature skeleton. However, patient compliance and diligent follow-up appear to be paramount for the success of this method of treatment. We currently offer this approach as a first-line treatment for PC.

Pectus Carinatum Evaluation Questionnaire (PCEQ): a novel tool to improve the follow-up in patients treated with brace compression

“…This conservative approach gained popularity in the last two decades and is now the first-line therapy for CG type [5,6]. Considering that the major complaint of these patients is body image, brace compression has the advantages of being non-invasive and more cost-effective, and avoids an operative scar [6][7][8][9][10]. Nevertheless, brace compression can be complicated by local pain and skin erosion, and may be an obstacle for physical activity and social life [3,8,11].…”

“…Nevertheless, brace compression can be complicated by local pain and skin erosion, and may be an obstacle for physical activity and social life [3,8,11]. Since the results of brace therapy are related to the duration of compression, compliance is critical for success [3,7,10]. It seems that patients use brace compression for less time than prescribed, which extends the correction phase [8].…”

Pectus carinatum: When less is more

“…Since 2000, there have been many reports on REVIEW the use of classic braces for the treatment of the carinatum deformity. [40][41][42][43][44][45][46][47] In 2008, Martinez-Ferro et al [6] published an 8-year review on the use of a specially designed dynamic compression system (the FMF Dynamic Compression System) ( Fig. 11).…”

Current Options for the Treatment of Pectus Carinatum: When to Brace and When to Operate?

“…4,17-21 A wide range of success rates has been reported with other types of braces using a variety of protocols, varying from 40 to 100%. 16,[22][23][24][25][26][27] The large number of publications on bracing PC within the past 15 years attests to the increasing use of this modality versus surgery. A recent review recommended bracing as first line treatment for PC.…”

“…Most studies of bracing have identified lack of compliance as the main cause of failure. [16][17][18][19][20][21][22][23][24][25][26][27] Two recent studies have specifically looked into the issue of compliance. 25,29 Pessanha et al found that patients were likely to be noncompliant with duration rather than frequency of brace wear, that is, they wore the brace daily, but for shorter periods than prescribed.…”