title: Preliminary study of efficacy of cup suction in the correction of typical pectus excavatum.
abstract: OBJECTIVE
  This preliminary qualitative study evaluates the efficacy of cup suction in the correction of pectus excavatum (PE), and examines the place of this system as a strategic treatment and as an alternative to surgery.
  
  
  METHODS
  Between October 2011 and June 2014, a total of 84 patients (children and adult) presenting with PE were treated by cup suction, in our chest wall deformities unit. On first consultation, the patients with typical PE and with at least partial correction during the first application of cup suction and a maximal suction pressure for correction of less than 300 mbar (millibars) were included in this study. 11 patients were excluded from the present study as they presented with a complex carinatum/excavatum. The remaining 73 patients were divided into two groups: Group I, adult patients ≥ 18 year old, 17 patients. The mean age was 22.8 years old. Group II, pediatric patients <18 years old, 56 patients. The mean age was 11.5 years old. Medical photographic documentation was collected systematically. In addition, the depth of PE was measured. The management protocol involved: adjustment of cup suction, strengthening exercises, and clinical follow-up every two to three months. The evaluation criteria during, and on the completion of the trial were: depth of the PE, morbidity and treatment compliance. Partial and final results were evaluated by the patients, their parents, and doctor, using a qualitative scoring scale.
  
  
  RESULTS
  A total of 73 patients presenting typical PE (symmetric in 52 cases and asymmetric in 21 cases) were treated by cup suction. The mean depth of PE was 23 mm (9-44). Of the 73 patients, one adult abandoned treatment and three children abandoned follow-up. The mean time of use of the device was 4h daily. At six months of treatment, the mean depth of PE was 9 mm (0-30) across all patients. 23 patients completed the treatment and exhibited flattening of the sternum. These patients were considered to have an excellent aesthetic result. The mean treatment duration to normal reshape was achieved at 10 months (4-21). The remaining patients are improving under continuing active treatment. The mean depth of PE in this group was 12 mm (4-30), after a mean treatment duration of 9 months (2-22).
  
  
  CONCLUSIONS
  Treatment using cup suction is a promising useful alternative in selected cases of symmetric and asymmetric PE, providing that the thorax is flexible. Treatment duration is directly linked to age, severity and the frequency of use. It is becoming a well-recognized therapy, which improves the self-image of those patients whose anterior chest wall is still pliable. The cup suction can be used for pediatrics and young adults waiting for a treatment, possibly surgery, however, the long-term effect of this procedure remains unclear.
authors.affiliation: Unit of Chest Wall Deformities Children and Adults, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France; Department of Pediatric Surgery & Urology, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France; Department of Physiology Clinical of Exercise, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France. Electronic address: manuel.lopez@chu-st-etienne.fr.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.affiliation: Unit of Chest Wall Deformities Children and Adults, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France; Department of General and Thoracic Surgery, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Patoir
authors.affiliation: Department of Physiology Clinical of Exercise, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Costes
authors.affiliation: Department of Pediatric Surgery & Urology, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France; Department of Physiology Clinical of Exercise, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France.
authors.forename: François
authors.initials: F
authors.lastname: Varlet
authors.affiliation: Department of Physiology Clinical of Exercise, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Barthelemy
authors.affiliation: Unit of Chest Wall Deformities Children and Adults, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France; Department of General and Thoracic Surgery, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France; Department of Physiology Clinical of Exercise, University Hospital of Saint Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004954:Esthetics; D005260:Female; D005660:Funnel Chest / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D012649:Self Concept; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cup suction; Non-operative treatment; Pectus excavatum