title: Prosthesis-free repair of pectus chest deformity.
abstract: BACKGROUND
  Modified Ravitch and Nuss procedures use a metal bar to repair pectus chest deformity; an additional procedure is required to remove the bar. The aim of this study was to examine mid-term results of a novel technique that uses the patient's own chest wall muscles to stabilize the pectus repair aided by a posture-maintaining exercise regimen.
  
  
  METHODS
  Thirty-two consecutive patients with pectus deformity underwent pectus repair without prosthesis between 1999 and 2008. The median age of the group was 18 (95 per cent confidence interval (c.i.) 14 to 34) years. Median follow-up was 44 (7 to 108) months. Twenty patients had an excavatum and 12 a carinatum defect. Surgery was performed through a transverse incision raising pectoralis and rectus muscle flaps. The sternum was released to a neutral position and stabilized to the overlying muscle raphe closure. Patient satisfaction was assessed with a single-step questionnaire.
  
  
  RESULTS
  Median length of stay was 6 (95 per cent c.i. 4 to 7) days. Two patients returned to theatre for bleeding, two had a superficial wound infection and four developed a seroma. No patient had recurrence. There was a significant improvement in self-esteem (P < 0·001) and a high level of overall satisfaction (median score 72, 95 per cent c.i. 56 to 80).
  
  
  CONCLUSIONS
  This non-prosthetic pectus deformity repair was effective with low serious morbidity and high patient satisfaction without the inherent disadvantages of using a metal bar.
authors.affiliation: Regional Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: T P
authors.initials: TP
authors.lastname: Makarawo
authors.forename: R S
authors.initials: RS
authors.lastname: Steyn
authors.forename: B V
authors.initials: BV
authors.lastname: Naidu
mesh_terms: D000293:Adolescent; D000328:Adult; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D018482:Muscle, Skeletal / Q000637:transplantation*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012649:Self Concept; D013524:Surgical Flaps; D013909:Thorax / Q000002:abnormalities*; D055815:Young Adult