Management of postoperative infections after the minimally invasive pectus excavatum repair.
OBJECTIVE
Pectus excavatum is frequently repaired using the minimally invasive placement of a substernal bar (Nuss procedure). Infectious complications after the Nuss procedure are potentially devastating. To date, the management of postoperative infectious complications has not been well described.


METHODS
A retrospective review of all patients (N = 168) who underwent the Nuss procedure from January 1, 1997, to October 1, 2003, at our institution was performed. Six patients (4%) had postoperative infections, and their medical records were reviewed.


RESULTS
Of the 6 patients, 5 underwent operative drainage for wound abscesses that developed 2 to 76 weeks postoperatively. The other patient developed cellulitis 12 months postoperatively and was treated effectively with antibiotics alone. Recurrent infections were treated in 3 of 6 patients, one of whom eventually required removal of the bar resulting in a mild, residual pectus excavatum defect. One of 6 patients has had the substernal bar removed electively. The remaining 4 continue to be without clinically apparent infection at this time and are over 1 year removed from their infection.


CONCLUSIONS
Although uncommon, infectious complications after the Nuss procedure require complex management strategies. Despite recurrent infection in some cases, most infectious complications occurring after the minimally invasive repair can be effectively treated without having to remove the substernal bar.
The Children's Mercy Hospital, University of Missouri, Kansas City School of Medicine, Kansas City, MO 66408, USA.
Casey M
CM
Calkins
Stephen B
SB
Shew
Ronald J
RJ
Sharp
Daniel J
DJ
Ostlie
Suzanne M
SM
Yoder
George K
GK
Gittes
Charles L
CL
Snyder
Wendy
W
Guevel
George W
GW
Holcomb
D000038:Abscess / Q000188:drug therapy*; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013530:Surgical Wound Infection / Q000188:drug therapy*; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents