Quadrangular Fixation of Pectus Bars to Prevent Displacement in Nuss Procedure

Abstract

Background Double pectus bars are sometimes inserted to correct pectus excavatum. Method of double-bar fixation to prevent bar displacement has been rarely reported. We have used quadrangular fixation of the double pectus bars. The objective of this study was to compare results of the quadrangular fixation procedure with those of the classic separate fixation procedure. Methods From September 2011 to January 2016, 86 patients underwent Nuss procedure with double-bar insertion. In 44 patients, each bar was fixed separately (group A). In 42 patients, quadrangular fixation of the bars was performed with metal plates (group B). Patient demographics, Haller index (HI), bar displacement index (BDI), and reoperation rate were compared between the two groups. Results The mean patient age was 17.2 years (range: 3–40 years) in group A and 17.8 years (range: 4–30 years) in group B. There was no significant difference in preoperative or postoperative HIs between the two groups (all p >0.05). Early complication rates were 15.9% in group A and 9.5% in group B (p > 0.05). In group A, three patients underwent surgery to correct bar displacement (6.8% of reoperation rate), whereas there was no corrective surgery in group B. BDIs of the two groups were significantly different (p < 0.01). Conclusions When quadrangular fixation was performed with upper and lower pectus bars bilaterally fixed by connecting each bar with plates, bar displacement was prevented more effectively than separate fixation, thus minimizing reoperation.

The Cross-Bar Technique for Pectus Excavatum Repair: A Key Element for Remodeling of the Entire Chest Wall

“…The surgical technique, of course, did not impact the early complications in favor of either group (4.5% and 3.3% in group C and group P, respectively). The late complication rates were similar to other series of multiple bar placement 8,15,18 . Wound infection was the most frequent late complication (4%) as reported in another large study 19 .…”

The changes of distance between nipples following correction of women pectus excavatum

“…Various techniques, such as the Ravitch procedure 15 , Nuss procedure 16 , and their modifications 17 , had been used to correct pectus excavatum. In this study, the authors have performed needlescope-assisted three-point fixation 18 , with or without quadrangular fixation 19 of the pectus bars which was a technique invented to avoid bar displacement, a common and serious complication of the Nuss procedure.…”

“…We analysed the medical records and computed tomography (CT) findings of 22 selected patients who had been diagnosed with pectus excavatum at Incheon St. Mary’s Hospital between October 2011 and September 2020. The patients had needlescope-assisted three-point fixation 18 done both with and without pectus bar quadrangular fixation 19 . This is modification of Nuss procedure.…”

The changes of distance between nipples following correction of women pectus excavatum

“…Various techniques, such as the Ravitch procedure 15 , Nuss procedure 16 , and their modi cations 17 , had been used to correct pectus excavatum. In this study, the authors have performed needlescope-assisted three-point xation 18 , with or without quadrangular xation 19 of the pectus bars which was a technique invented to avoid bar displacement, a common and serious complication of the Nuss procedure.…”

“…We analysed the medical records and computed tomography (CT) ndings of 22 selected patients who had been diagnosed with pectus excavatum at Incheon St. Mary's Hospital between October 2011 and September 2020. The patients had needlescope-assisted three-point xation 18 done both with and without pectus bar quadrangular xation 19 . This is modi cation of Nuss procedure.…”