title: Thirty years' experience of open-repair surgery for pectus excavatum: development of a metal-free procedure.
abstract: OBJECTIVE
  Throughout the history of surgery for pectus excavatum (PE), the Nuss procedure and open repair have been performed with many modifications, with most of these procedures using a metal bar. However, the use of a metal bar has several drawbacks. Thus, we aimed to develop a procedure that did not require a metal bar.
  
  
  METHODS
  Through our experience of 426 pediatric cases that underwent various procedures for open repair of PE at Nagoya City University, we arrived at the current procedure that we describe herein. We have evaluated this procedure by review of clinical results and deformity indices (Haller's, steepness, excavation volume, and asymmetry index).
  
  
  RESULTS
  The latest and current procedure that supports the sternum with a bridge constructed by the 4th or 5th costal cartilages is associated with fewer complications, a lower re-operation rate, and striking improvement in the indices examined.
  
  
  CONCLUSIONS
  Our current open-repair procedure that does not require a metal bar is recommended for correction of deformities of PE in children.
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Masaoka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Shingi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Fujio
authors.initials: F
authors.lastname: Hara
authors.forename: Takeo
authors.initials: T
authors.lastname: Mizuno
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamakawa
authors.forename: Toru
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D002356:Cartilage / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008670:Metals; D010027:Osteotomy / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012086:Reoperation / Q000706:statistics & numerical data; D012272:Ribs / Q000601:surgery; D012720:Severity of Illness Index; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008670:Metals