Operative management of acquired Jeune's syndrome.
BACKGROUND
Acquired Jeune's syndrome is a severe iatrogenic deformity of the thoracic wall following a premature and aggressive open pectus excavatum repair. We report herein our technique and experience with this rare condition.


METHODS
From 1996 to 2011, nineteen patients with acquired Jeune's syndrome were retrospectively identified in a tertiary referral center. The technique used to expand and reconstruct the thoracic wall consisted of 1) release of the sternum from fibrous scar tissue, 2) multiple osteotomies along the lateral aspect of the ribs with anterior advancement of costal-cartilages to protect the heart, 3) stabilization of the thorax by placing a curved bar for retrosternal support and, 4) restoration of the sterno-costal junction by wiring the lower cartilages to the edge of the sternum.


RESULTS
Major complications observed in this series were: bar displacement (seven cases), postoperative death from cardiac arrest following bronchoscopy (one case), late cardiac tamponade from migration of wire suture fragment (one case), and need for multiple reoperations (one case). Long-term cosmetic results and improvement in daily quality of life were reported as positive in the majority of cases.


CONCLUSIONS
Anterior chest wall reconstruction successfully treated our series of patients with acquired Jeune's syndrome. This multifaceted technique is an effective procedure that allows expansion of the thoracic cavity and improvement of aerobic activity.
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Maria Grazia
MG
Sacco Casamassima
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Seth D
SD
Goldstein
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jose H
JH
Salazar
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Dominic
D
Papandria
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kimberly H
KH
McIltrot
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
David E
DE
O'Neill
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Fizan
F
Abdullah
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: pc@jhmi.edu.
Paul M
PM
Colombani
D001864:Bone Wires; D001999:Bronchoscopy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D004954:Esthetics; D005260:Female; D005548:Foreign-Body Migration; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D007223:Infant; D016268:Internal Fixators; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D011300:Preoperative Care; D011788:Quality of Life; D011859:Radiography; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D013577:Syndrome; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology / Q000601:surgery*
Asphyxiating thoracic dystrophy; Jeune's syndrome; Recurrent Pectus excavatum