title: The use of a lateral stabilizer increases the incidence of wound trouble following the Nuss procedure.
abstract: BACKGROUND
  A lateral stabilizer has been used to prevent bar displacement during the Nuss procedure for pectus excavatum repair in pediatric patients. We experienced wound troubles in patients who had a stabilizer placed within them. The aim of this study was to examine the effect of a lateral stabilizer and other clinical factors on wound troubles after the Nuss procedure.
  
  
  METHODS
  53 patients with pectus excavatum underwent repair by the Nuss procedure. Preoperative clinical data, operative data, and postoperative complications were examined in all patients.
  
  
  RESULTS
  A lateral stabilizer was placed in 29 of the 53 patients. Short-term results were excellent in 42 patients (79.2%). Postoperative complications involved pneumothorax requiring drainage in two patients, atelectasis in one patient, pleural effusion in three patients, deterioration of scoliosis in one patient, erythema in one patient, persistent pain in two patients, bar displacement in four patients, and local wound complications (Seroma with dermatitis due to pressure damage) in five patients. All seromas with dermatitis due to pressure damage were initially aseptic around lateral stabilizers and became infected in four patients after resection of the seroma or spontaneous perforation. Removal of both the pectus bar and lateral stabilizer was performed in two of those four patients and the lateral stabilizer was removed in the other two patients to prevent catastrophic infection such as empyema or mediastinitis. The use of a lateral stabilizer increases the incidence of wound trouble (p = 0.041).
  
  
  CONCLUSIONS
  Although the Nuss procedure has evolved into an effective method for pectus excavatum repair, the use of a lateral stabilizer increases the incidence of wound difficulties.
authors.affiliation: Department of Cardiothoracic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. atsushiw@sapmed.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takuro
authors.initials: T
authors.lastname: Obama
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Ohsawa
authors.forename: Tooru
authors.initials: T
authors.lastname: Mawatari
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ichimiya
authors.forename: Tomio
authors.initials: T
authors.lastname: Abe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D044967:Serum; D012871:Skin Diseases / Q000453:epidemiology / Q000209:etiology; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation