Acquired deformities of the anterior chest wall.
BACKGROUND
Acquired chest wall deformities are difficult to describe and to classify. We propose the following classification and treatment options.


METHODS
We observed 11 patients with acquired deformities (AD) that required surgical correction.


RESULTS
AD of the chest can be classified into 4 groups: (1) AD resulting from a pathological process within the thorax (heart enlargement, mediastinal tumors), (2) AD resulting from chest wall disease (rib osteomyelitis or tumors), (3) iatrogenic deformities (following rib graft harvesting, acquired Jeune's syndrome), and (4) post-traumatic deformities. Group 1 requires treatment of the pathological process. Group 2 is guided by oncological or infectious disease principles. Groups 3 and 4 require chest wall reconstruction. Iatrogenic AD usually occur after pectus excavatum repair with rib cartilage extirpation in young patients, which results in a reduced, restricted thorax. Post-traumatic AD often have pathological chest wall mobility owing to pseudo-articulation of injured ribs.


CONCLUSIONS
To prevent AD formation and to protect thoracic growth and mobility, costosternal and costochondral junctions should be preserved during cartilage resection. Substernal suturing of the perichondrium should be avoided.
The Department of Thoracic and Cardiovascular Surgery, Heineman Medical Research Laboratories, Carolinas Medical Center, Charlotte, NC 28203, USA. Alexander.Fokin@carolinashealthcare.org
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D002356:Cartilage / Q000293:injuries / Q000601:surgery; D005660:Funnel Chest / Q000150:complications / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D009139:Musculoskeletal Abnormalities / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D012272:Ribs / Q000293:injuries / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D035441:Thoracic Wall / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome