The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction?

Abstract

The vacuum bell has proved to be an alternative therapeutic option in selected patients with PE. The initial results proved to be dramatic, but long-term results are so far lacking, and further evaluation and follow-up studies are necessary. In addition, the method may assist the surgeon during the MIRPE procedure.

Advances in the management of pectus deformities in children

“…A minimally invasive reverse Nuss procedure for the treatment of PC employs a similar procedure, though the bar is placed in front of the sternum and fixed to the ribs in a compressing position [2]. Proposed advantages to the minimally invasive Nuss procedure includes shorter operative times, minimal blood loss of less than 90 mL, immediate postoperative extubation, avoidance of instability of the chest wall, maintenance of chest wall elasticity and absence of a large surgical incision, making the Nuss procedure more suited to address psychosocial issues associated with pectus deformity [37,41,44,45]. Disadvantages of this minimally invasive repair includes considerable analgesic requirement, a challenging postoperative course in regards to pain control, increased length of hospitalization, and longer and more severe limitations in activity when compared with the open Ravitch procedure [2,4,23,45,46].…”

“…Nevertheless, the minimally invasive nature of the Nuss procedure, the superior cosmetic outcomes, the exceedingly low mortality rate comparable to that of the Ravitch repair, and an overall complication rate similar to that of the Ravitch repair have made the Nuss technique the current preferred modality for surgical repair of pectus deformity until further large-scale prospective randomized studies comparing the two procedures suggest otherwise. [4,48]  Reduction of FVC after bar placement [47] Patients >15 years of age are at higher risk for complications [41] Dynamic Compression Bracing Custom-fitted aluminum brace assembled to form a rigid belt that surrounds the thoracic wall at the level of the defect [15]  No risk of anesthesia [15]  No visible scar [15]  No hospital admission [15]  Reduced cost to treat [15]  Skin ulceration [15]  Social discomfort [15]  Back pain [15]  Hematoma [15]  Recurrence [15]  Pressure necrosis [15]  May only remove brace when showering or playing sports [15] Patients with severe deformities require higher compression pressures, resulting in an increased complication rate [15] Vacuum Bell Suction cup applied to chest wall, creating a vacuum that sucks deformity outward [2,44]  No risk of anesthesia [44]  No risk of a major surgical procedure [44] …”

“…Treatment is accomplished via a suction cup applied directly to the chest wall, in order to create a vacuum that places outward traction on the chest concavity. A vacuum up to 15% below atmospheric pressure gradient is created by the patient using a hand pump, and must be used for at least 30 minutes, twice daily, for a minimum of 30 days [44]. The application of the vacuum bell must be performed under careful supervision in children under the age of 10, as the force of the vacuum can lead to rapid sternal and rib elevation, deforming the chest within minutes [44].…”

“…The application of the vacuum bell must be performed under careful supervision in children under the age of 10, as the force of the vacuum can lead to rapid sternal and rib elevation, deforming the chest within minutes [44]. Additional complications associated with this treatment modality include subcutaneous hematoma, petechial bleeding, dorsalgia and transient paresthesia of the upper extremities during the application, and rib fractures, though currently available data indicates that the vacuum bell is relatively well tolerated by both the pediatric and adult population [44]. The vacuum bell is contraindicated in Osteogenesis Imperfecta, Glisson's disease, vasculopathies (e.g.…”

“…A vacuum up to 15% below atmospheric pressure gradient is created by the patient using a hand pump, and must be used for at least 30 minutes, twice daily, for a minimum of 30 days [44]. The application of the vacuum bell must be performed under careful supervision in children under the age of 10, as the force of the vacuum can lead to rapid sternal and rib elevation, deforming the chest within minutes [44]. Additional complications associated with this treatment modality include subcutaneous hematoma, petechial bleeding, dorsalgia and transient paresthesia of the upper extremities during the application, and rib fractures, though currently available data indicates that the vacuum bell is relatively well tolerated by both the pediatric and adult population [44].…”