title: A next-generation pectus excavatum repair technique: new devices make a difference.
abstract: BACKGROUND
  When performing pectus excavatum repair using a pectus bar, stabilization of the bar is crucial. However, since 2007, we have been developing new devices to achieve a bar dislocation rate of zero. The purpose of this study is to determine whether our next-generation approach makes it possible to achieve our goal.
  
  
  METHODS
  We analyzed the results of various bar fixation techniques in a patient cohort of 1,816 consecutive pectus excavatum repairs using a pectus bar between 1999 and 2012. Techniques that have been evolving were a stabilizer (STB, 1999); multipoint pericostal suture fixation (MPF, 2001); and the new devices: claw fixator (CFT, 2007) and hinge plate (HP, 2009). The claw fixator is used for sutureless bar fixation by hooking the rib with blades, whereas the hinge plate prevents intercostal muscle stripping at the hinge points. Patients were divided into groups according to the technique used, and the outcomes were compared.
  
  
  RESULTS
  Early bar dislocation rates were as follows: STB 3.33% (6 of 180), MPF 0.56% (4 of 760), CFT 0.57% (4 of 699), and CFT+HP 0% (0 of 177; p = 0.002). Reoperation rates were as follows: STB 5% (9 of 180), MPF 1.57% (12 of 760), CFT 2.10% (11 of 699), and CFT+HP 3.38% (6 of 177; p = 0.042). Total complication rates were also lower in the CFT+HP group (14.1%, 25 of 177) than the STB group (22.7%, 41 of 180; p < 0.01).
  
  
  CONCLUSIONS
  By using the next-generation approach with the claw fixator plus hinge plate rather than the conventional stabilizer, we were able to reduce the bar dislocation rate and complications. We recommend that the conventional stabilizer be replaced with the claw fixator and hinge plate.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea. Electronic address: hyjpark@catholic.ac.kr.
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Sungsoo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea.
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Jeon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007223:Infant; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019616:Thoracic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D055815:Young Adult