Pectus Excavatum Reconstruction With Silicone Implants

Abstract

Pectus excavatum, or funnel chest, is an anterior chest wall deformity, characterized by a depressed sternum. Frequently used techniques for pectus excavatum repair are extensive thoracic surgical corrections at a young age. At an adult age, custom-made silicone implants can be used as a less extensive surgical option. Thus far, there are only a limited number of reports in the English-language literature concerning this treatment modality. We evaluated our series of 16 patients treated with custom-made silicone implants, assessing complications, patient satisfaction, and aesthetic outcome. Seven patients (44%) had complications, mostly seroma formation (31%). Ten of 12 patients (83%), who were evaluated at the long-term, reported improved patient satisfaction and 9 of 13 patients (69%), in whom aesthetic results were assessed, had a good or excellent aesthetic outcome.Our study, combined with a review of the English-language literature, demonstrates that there is a place for custom-made silicone implants in the treatment of pectus excavatum, especially in less severe cases at an adult age. Preoperative counseling with emphasis on the likelihood of seroma formation is advocated.

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

“…Forty-four articles met the criteria for inclusion. These were stratified based on age range and treatment, providing seven subgroups: Nuss adult (n = 8) [32,35-41], Nuss pediatric (n = 22) [21,23-25,27,29,30,32,33,35],[39,42-52], Ravitch adult (n = 3) [53-55], Ravitch pediatric (n = 11) [24,25,27,29,30,55-60], Robicsek pediatric (n = 2) [57,61], Implant adult (n = 3) [18,20,62]. No other treatments had articles that satisfied the inclusion criteria.…”

“…Also in the 1960s cosmetic interventions became available for asymptomatic PEx patients [17]. Today, silicon implants and polyethylene implants are manipulated to cosmetically fix the deformity [18-20]. In 1998, Nuss introduced a minimally invasive repair, temporarily implanting metal bars to alter the curvature of the anterior chest wall.…”

Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

“…The most often used are methyl methacrylate implants 3 or titanium plates 6 coated with sealed prolene mesh from inside and outside of the chest wall (sandwich technique), Marlex, polytetrafluoroethylene or Vicryl. 7 In addition, the following are also used: Ley’s prostheses in the form of a titanium plate in the shape of a footprint fixed to the ribs with metal threads, 8 sternum and rib fragments made of titanium in 3D technique, 9 , 10 silicone implants made on the basis of a patient’s chest print before the surgery (in this case, most complications are observed, like recurrent serous exudate up to 31%), 11 autografts of osseous tissue and muscle fragments 6 and allografts of the sternal fragment from deceased donors. 4 Implant should be resistant to forces acting on chest skeleton, plastic so as to adjust it according to the size of the sternum defect, translucent for X-rays 7 and also made of a material which is not a breeding ground for bacterial flora.…”

“…The most often observed are the complications associated with respiratory disorders. 11 Other known complications connected with sternum implants are chronic pains, chest deformations, local pleural thickening, necrosis of used pedicle muscle lobes, 6 mediastinitis and loosening of the implant mounting resulting in instability of the chest. Sternal implant fracture has also been reported.…”

The use of soft silicone solid implant molded intraoperatively for pectus excavatum surgical repair

“…In those cases that used gelatinous implants, the discrepant measures resulted in visible and palpable edges upon physical examination, which are even more visible during upper limb movements. ( 9 ) The final external appearance shows rectified and relief-free skin because of the type of surface of the implants.…”