title: Evaluation of pectus bar position and osseous bone formation.
abstract: OBJECTIVE
  Minimally invasive repair has become a popular approach for pectus excavatum (PE). The bar is secured to the thoracic wall and left for approximately 2 years. The authors have noticed an intense bone formation (BF) around some of these bars at removal. A review of children undergoing bar removal was performed to better understand this BF in relation to bar placement.
  
  
  METHODS
  A retrospective review of children undergoing bar removal after PE repair since January 1998 was performed. Chart review included age at bar insertion and removal, bar insertion position (subcutaneous [SC] v submuscular [SM]), BF on Chest x-ray and at bar removal, operating time, and estimated blood loss (EBL).
  
  
  RESULTS
  Thirty-six patients underwent bar removal during the study period (16 SC and 20 SM). Chest x-ray evaluation was possible in 27 patients (16 SM, 11 SC). No difference existed for length of time the bar was in place or age at insertion/removal between groups. EBL was higher in the SM (18.3 v 8.8 mL, not significant). BF was seen radiographically in 15 SM and 3 SC patients (P <.001). BF was encountered at removal in 19 SM patients and a single SC patient (P <.001). Operating time was statistically longer (P <.01) for the SM group (30.2 v 15.6 min).
  
  
  CONCLUSIONS
  Bar position during repair of PE is important. SM positioning virtually always results in BF with increased EBL and statistically longer operating time at removal. Careful placement of the bar in the SC position without violating the fascia should be used to avoid these undesirable effects.
authors.affiliation: The Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: Julie K
authors.initials: JK
authors.lastname: Marosky
authors.forename: Troy L
authors.initials: TL
authors.lastname: Spilde
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: George K
authors.initials: GK
authors.lastname: Gittes
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sharp
mesh_terms: D016063:Blood Loss, Surgical; D002648:Child; D020878:Device Removal / Q000379:methods*; D005549:Foreign-Body Reaction / Q000000981:diagnostic imaging / Q000378:metabolism*; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D010012:Osteogenesis / Q000502:physiology*; D019736:Prostheses and Implants; D011859:Radiography; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D013997:Time Factors