Pectus excavatum

As funnel chest ( pectus excavatum immersive infundibulum ) is called a lesion of the chest. Due to changes in the cartilage connections between sternum and ribs, the front part of the chest sinks.

Frequency

The incidence is about 1:300 to 1:400 births. Boys are three times more often affected than girls. A familial aggregation is observed in 35 %. The pectus excavatum also occurs frequently in Marfan syndrome, Poland syndrome and the fetal alcohol syndrome.

Follow

The functions of the heart and lungs may be affected, depending on the degree of severity, and physical malpositions occur. The shoulders are usually inclined forward and hang easily, the back has a kyphosis, the abdomen protrudes.

A possibly increased intra-abdominal pressure on the cardia by a malposition in the abdominal area may have a chronic reflux esophagitis result.

Due to the poor posture often leads to a strong load on the intervertebral discs, which brings with it pain in the entire area of ​​the spine (such as low back pain, sciatica, Thoracic ).

Diagnostics

The deformity is visible externally. They usually occur within the first year of life, but takes the deformation until the completion of growth. The full extent of which can be visualized by CT. After consequential damages is sought by means of pulmonary function test and ECG or echocardiography. In addition, the spine should be examined, eg by x-ray to rule out other medical conditions.

Other malformations of the thorax are the pigeon chest and Harren stone deformity.

Treatment

However, physiotherapy can be corrected by means of the faulty posture that pectus excavatum not. Consequential damages you can narrow down or even prevented by the back muscles are trained to counter the incorrect loading of the intervertebral discs.

The indication for surgical correction of pectus excavatum results from the psychological and physical impairment by the malformation. The operations run normally pediatric surgeons or thoracic surgeons.

Suction cup

By means of a suction cup should be slowly raised through regular application of the chest. This method is relatively new, a long-term study is currently being conducted at the University Clinic in Jena. This suction cup must be used one hour a day and the. Over a period of two to three years User and the manufacturer company believe it is possible that the suction cup can make the surgical treatment in the future superfluous.

Minimally Invasive Technique

In the so-called "nut - OP", which was first described in 1998 by Donald Nuss, a personalized reasonable and pre-bent metal bracket is pushed under the sternum through two small cuts on the sides under the arms. This pushes the sunken sternum and the affected ribs outward. The bracket is fixed to the side. In some cases, two or three bars are introduced. The results are immediately visible.

Most of the brackets remain for two to three years in the body and is then surgically removed; in elderly patients, a longer time is required. The method is carried out in Germany since 1999. Due to the small scars, many patients prefer this method of the open method according to Mark Michael Ravitch.

The minimally invasive funnel chest correction method was methodically von Rokitansky, including through grooves in the sternum, thoracoscopic slotting the costal cartilages and by the use of a single-piece support implant ( metal bracket ), where there is no metal wear in the body, further developed.

Open surgery

The techniques date back to Mark Ravitch or Fritz Rehbein and Hans Hellmut Wernicke.

During surgery, the chest is opened by a several -centimeter-long vertical section ( for men) or horizontal section (in women). Then the deformed ribs are separated from the sternum. Gristle of the deformed ribs are removed. The sternum is sawed, then lifted and secured with metal straps. Thereafter, the chest is closed.

The further developed in Erlangen by Hans Peter Hümmer operation ( Minimized Erlanger correction method, MEK ) largely dispensed with the complete separation of the ribs. Instead, the ribs are only angekerbt on approach to the sternum. With the tensiometer while the voltage is measured that is necessary to raise the sternum. Compared to other surgical methods much more gentle, this method shortens the postoperative laytime. It is currently the only one that can show the long-term results after several decades, and is applicable to both symmetric and asymmetric Brustwanddeformitäten.