Finite element analysis ofpectus carinatumsurgical correction via a minimally invasive approach

Abstract

Pectus carinatum (PC) is a chest deformity caused by a disproportionate growth of the costal cartilages compared to the bony thoracic skeleton, pulling the sternum towards, which leads to its protrusion. There has been a growing interest on using the 'reversed Nuss' technique as a minimally invasive procedure for PC surgical correction. A corrective bar is introduced between the skin and the thoracic cage and positioned on top of the sternum highest protrusion area for continuous pressure. Then, it is fixed to the ribs and kept implanted for about 2-3 years. The purpose of this work was to (a) assess the stresses distribution on the thoracic cage that arise from the procedure, and (b) investigate the impact of different positioning of the corrective bar along the sternum. The higher stresses were generated on the 4th, 5th and 6th ribs backend, supporting the hypothesis of pectus deformities correction-induced scoliosis. The different bar positioning originated different stresses on the ribs' backend. The bar position that led to lower stresses generated on the ribs backend was the one that also led to the smallest sternum displacement. However, this may be preferred, as the risk of induced scoliosis is lowered.

Clinical significance of concomitant pectus deformity and adolescent idiopathic scoliosis: systematic review with best evidence synthesis

“…One study was identified by backward citation. Eventually, 48 studies were included: 19 in category I [ 5 , 9 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ], 21 in category II [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , and 8 in category III [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] ( Figure 1 ).

Figure 1 PRISMA 2020 flow diagram of identification, screening, and inclusion of papers in the 3 categories.

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“…Five studies focused on the change of thoracic pressure distribution after PD correction [ 25 , 58 , [60] , [61] , [62] ]. CT models correctly predicted surgical outcome [ 25 , 61 , 62 ].…”

“…reported an aggravation rate in fully grown adolescents and twice as high as in progressive AIS's most severe form [ 20 , 63 ]. Moreover, it was demonstrated that the metallic bars used in the Nuss procedure administer asymmetric pressure on the thorax [ 25 , 58 , 60 , 61 ]. In addition, cases were reported in which a postural preference, because of postoperative pain, provoked AIS [27] and in which Nuss-acquired scoliosis improved immediately after bar removal [24] .…”

Patient-specific outcome simulation after surgical correction of Pectus Excavatum: a preliminary study

“…The virtual bar was created in a computer-aided design software, i.e. Solidworks, (SolidWorks Corp., Concord, MA, USA) 33 . The material properties of titanium alloy Ti-6Al-4V were considered for the bar 34 .…”

Treatment of children with a rare form of congenital chest deformity

“…CLINICAL CASES ковом возрасте [4,5,6,7]. Использование известных современных малоинвазивных технологий лечения деформаций грудной клетки при данном пороке значимого клинического эффекта не дает [8][9][10][11].…”