title: Pectus excavatum: special surgical technique, perioperative management and long-term results.
abstract: BACKGROUND
  It is generally accepted that pectus excavatum should be repaired in childhood if possible. The procedure could be performed conveniently even without implantation of any foreign material. In contrast there are several adult patients with aesthenic or marfanoid habitus and poor thorax cosmetics, who seek medical help especially surgical correction due to late awareness or cardiopulmonary dysfunction.
  
  
  METHODS
  Between 1989 and 1997, 22 adult patients (mean age 26 years, 18 males and 4 females) underwent repair of the pectus excavatum in our institution. Patients data were analysed retrospectively. Indication was mainly for aesthetics or cardiopulmonary symptoms, in 3 patients for recurrence after primary repair elsewhere. The total surgical repair technique consisted of V-shape osteotomy of the ribs at the outer and inner limit of the funnel and transverse osteotomy of the sternum without displacement of the posterior cortical The sternal and chest wall stabilization in corrected position was performed with at least two metal struts installed transsternal and transversely. In most of our cases other diagonal struts on both sides were needed to achieve further stabilization of the lowest costal cartilages. The metal struts are removed 1 year after the procedure.
  
  
  RESULTS
  All repairs were completed with a low complication rate. Chest radiographs and pulmonary function studies were performed routinely before and after corrective surgery. Good to satisfactory chest contour was achieved in 20 patients (91%), with a follow-up from 5 months to 8 years.
  
  
  CONCLUSIONS
  Our current technique with perioperative management is successfully performed in adults and will be presented.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Westfaelische Wilhelm University, Muenster, Germany.
authors.forename: T D
authors.initials: TD
authors.lastname: Tjan
authors.forename: M
authors.initials: M
authors.lastname: Semik
authors.forename: H
authors.initials: H
authors.lastname: Rotering
authors.forename: N
authors.initials: N
authors.lastname: Rolf
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D000328:Adult; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D016896:Treatment Outcome