title: [Chest wall distraction in thoracogenic scoliosis].
abstract: BACKGROUND
  Combined congenital scoliosis and rib fusion associated with other chest deformities during infancy can lead to a progressive hypoplastic thorax that could be unable to support normal lung growth and respiratory function. Campbell introduced an expansion thoracoplasty technique in which fused ribs are separated and a vertical expandable prosthetic titanium rib is used as a chest wall distraction device to enlarge the affected hemithorax. This technique benefits the underlying lung by improving the thoracic volume and the respiratory function.
  
  
  METHODS
  Four patients (3 boys and 1 girl) with severe unilateral thoracic deformity with combined scoliosis and rib fusion plus a restrictive respiratory insufficiency are presented herein; 1 of them needed continuous CPAP preoperatively. All had progressive scoliosis and failure to thrive. Preoperative evaluation included three-dimensional CT reconstruction. A thoracic expansion placing an intercostal vertical expandable prosthetic titanium device as a chest wall distractor was performed. Afterwards, distraction control was made every four months.
  
  
  RESULTS
  Our 4 patients had a satisfactory outcome. Scoliosis was corrected and there were improvements of volume and function of the thorax.
  
  
  CONCLUSIONS
  The placement of an intercostal distractor device improves the thoracic insufficiency syndrome, lengthening and expanding the thoracic cage at the same time. These effects benefit respiratory function and correct scoliosis, allowing an adecuate lung function.
authors.affiliation: Departamento de Cirugía Pediátrica, Hospital Universitario La Paz. lfavila73@hotmail.com
authors.forename: L F
authors.initials: LF
authors.lastname: Avila Ramírez
authors.forename: F
authors.initials: F
authors.lastname: Hernández
authors.forename: S
authors.initials: S
authors.lastname: Rivas
authors.forename: A L
authors.initials: AL
authors.lastname: Luis
authors.forename: J L
authors.initials: JL
authors.lastname: Encinas
authors.forename: L
authors.initials: L
authors.lastname: Martínez
authors.forename: F
authors.initials: F
authors.lastname: Sánchez Pérez-Grueso
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013902:Radiography, Thoracic; D012600:Scoliosis / Q000175:diagnosis* / Q000601:surgery; D035441:Thoracic Wall / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D013909:Thorax / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome