title: The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum.
abstract: OBJECTIVE
  This report describes the authors' experience using a vacuum to pull the abnormal chest wall outward in patients with pectus excavatum.
  
  
  METHODS
  A suction cup was used to create a vacuum at the chest wall. A patient-activated hand pump was used to reduce pressure up to 15% below atmospheric pressure. The device was used by 60 patients (56 males, 4 females), aged 6.1 to 34.9 years (median, 14.8 years), for a minimum of 30 minutes, twice a day, up to 5 hours per day (median, 90 minutes). Patient progress was documented using photography, radiography, and plaster casts of the defect. In 14 children this method was used during the Nuss procedure to enlarge the retrosternal space for safer passage of the introducer.
  
  
  RESULTS
  Follow-up occurred between 2 and 18 months (median, 10 months). Computed tomographic scans showed that the device lifted the sternum and ribs within 1 to 2 minutes; this was confirmed thoracoscopically during the Nuss procedure. The suction cup enlarged the retrosternal space for safer passage of the introducer. Initially, the sternum sank back after few minutes. After 1 month, an elevation of 1 cm was noted in 85% of the patients. After 5 months, the sternum was lifted to a normal level in 12 patients (20%) when evaluated immediately after using the suction cup. All patients exhibited moderate subcutaneous hematoma, although the skin was not injured. One patient suffered from transient paresthesis in the right arm and leg. Two patients experienced orthostatic disturbances during the first application of the suction cup. There were no other complications.
  
  
  CONCLUSIONS
  In patients with pectus excavatum, application of a vacuum effectively pulled the depressed anterior chest wall forward. The initial results proved dramatic, although it is not yet known how much time is required for long-term correction.
  
  
  CONCLUSIONS
  This vacuum method holds promise as a valuable adjunct treatment in both surgical and nonsurgical correction of pectus excavatum.
authors.affiliation: Department of Pediatric Surgery, University Medical Centre, 55101 Mainz, Germany. schier@kinderchir.klinik.uni-mainz.de
authors.forename: Felix
authors.initials: F
authors.lastname: Schier
authors.forename: Michael
authors.initials: M
authors.lastname: Bahr
authors.forename: Eckard
authors.initials: E
authors.lastname: Klobe
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D010342:Patient Acceptance of Health Care; D012272:Ribs / Q000000981:diagnostic imaging; D012648:Self Care; D013249:Sternum / Q000000981:diagnostic imaging; D040521:Subcutaneous Tissue; D014057:Tomography, X-Ray Computed; D014618:Vacuum; D014619:Vacuum Curettage / Q000009:adverse effects / Q000295:instrumentation