title: Contemporary management of recurrent pectus excavatum.
abstract: BACKGROUND
  Optimal management of recurrent pectus excavatum (PE) has not been established. Here, we review our institutional experience in managing recurrent PE to evaluate long-term outcomes and propose an anatomic classification of recurrences, and a decision-making algorithm.
  
  
  METHODS
  Clinical records of patients undergoing repair of recurrent PE (1996-2011) were reviewed. Univariate and multivariate logistic regression analyses were employed to examine patient characteristics as potential predictors for re-recurrence.
  
  
  RESULTS
  Eighty-five patients with recurrent PE were identified during the study period. The initial operation was a Ravitch procedure in 85% of cases. Revision procedures were most frequently Nuss repairs (N=73, 86%), with remaining cases managed via open approach. Overall cosmetic and functional results were satisfactory in 67 patients (91.8%) managed with Nuss and in 7 (58%) patients managed with other techniques. Seven (8%) patients required additional surgical revision. Multivariate analysis identified no statistically significant patient or procedural factors predictive of re-recurrence.
  
  
  CONCLUSIONS
  This study demonstrates that the Nuss procedure can be an effective intervention for recurrent pectus excavatum, regardless of the initial repair technique. However, open repair remains valuable when managing severe cases with abnormalities of the sternocostal junction and cartilage regrowth under the sternum.
authors.affiliation: Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: msaccoc1@jhmi.edu.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Sacco Casamassima
authors.affiliation: Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Dominic
authors.initials: D
authors.lastname: Papandria
authors.affiliation: Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Goldstein
authors.affiliation: Department of Health, Behavior &Society, Johns Hopkins Bloomberg School of Public Health, MD, USA.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Kimberly H
authors.initials: KH
authors.lastname: McIltrot
authors.affiliation: Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Department of Pediatric Surgery, All Children's Hospital Johns Hopkins, St Petersburg, FL, MD, USA. Electronic address: pc@jhmi.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D024162:Second-Look Surgery; D013249:Sternum / Q000601:surgery; D035441:Thoracic Wall / Q000601:surgery; D055815:Young Adult
keywords: Floating sternum; Pectus excavatum; Recurrent chest wall deformity