title: [The unsightly chest: Analysis and anomaly. Curative or palliative approach?]
abstract: Anterior chest wall deformity are mostly represented by pectus excavatum, which is a depression of the chondrosternal plastron from the 3rd to the 7th pairs of the costal cartilages, then by pectus carinatum which conversely represents a protrusion of this plastron. The major esthetic and psychosocial impact is not to be demonstrated anymore whereas the cardiopulmonary functional impact remains still highly debated. Regarding the management, curative surgical techniques such as Wurtz's sub-perichondrial simplified sternochondroplasty or Nuss' minimaly invasive technique are opposed to palliative filling technique such as customized silicone implant, lipostructure and flaps. In addition to these there are non-surgical techniques like suction bells (Vacuum Bell®) for pectus excavatum or compressive orthotic bracing for pectus carinatum. The morbidity and the mortality related to some of the heavy surgeries must be weighed up with esthetic, functional or both surgical indications in order to choose the proper management. The other known deformities are much rarer. Pectus arcuatum is a combined type requiring the same management principles. Sternal cleft is caused by a fusion defect of the sternal bars, which must be treated mainly by neonatal surgery. Acquired restrictive thoracic dystrophy is a consequence of early curative surgery.
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Salengro, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France. Electronic address: pierre.faglin@orange.fr.
authors.forename: P
authors.initials: P
authors.lastname: Faglin
authors.affiliation: Departement de chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
authors.forename: É
authors.initials: É
authors.lastname: Nectoux
authors.affiliation: Service de chirurgie plastique pédiatrique, hôpital Jeanne de Flandre, CHRU Lille, 2, avenue Oscar-Lambret, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Belkhou
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Salengro, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Guerreschi
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Salengro, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France. Electronic address: veronique.martinot@chru-lille.fr.
authors.forename: V
authors.initials: V
authors.lastname: Duquennoy-Martinot
mesh_terms: D001915:Braces; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D066166:Pectus Carinatum / Q000628:therapy*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures; D013249:Sternum / Q000601:surgery; D013525:Surgical Instruments
keywords: Acquired restrictive thoracic dystrophy; Chest wall deformity; Customized silicone implant; Dystrophie thoracique restrictive acquise; Fente sternale; Filling technique; Malformation de la paroi thoracique; Nuss procedure; Pectus carinatum; Pectus excavatum; Prothèse en silicone sur mesure; Sternal cleft; Sternochondroplastie; Sternochondroplasty; Technique de Nuss; Technique de comblement