title: Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children.
abstract: OBJECTIVE
  This report describes complications using the vertical expandable prosthetic titanium rib (VEPTR) for thoracic insufficiency syndrome (TIS) at a single center.
  
  
  METHODS
  This is a prospective cohort evaluating 65 patients with rib-rib and rib-spine VEPTR devices for TIS placed between 10/2001 and 11/2014, for children with spinal or chest wall deformity. Patients were classified using the early onset scoliosis classification system (C-EOS).
  
  
  RESULTS
  65 patients are available for follow up. 23 congenital scoliosis, 12 neuromuscular, 14 syndromic, 2 idiopathic and 14 not classifiable by the C-EOS system including 11 chest wall reconstructions. Average age at implantation was 6.9years (range 1.3-24.8) with average follow up 6.9years (range 0.4-14.8). 22 patients had 37 complications. Those classifiable by C-EOS had complications in the normo- and hyperkyphotic groups. Implant erosion and infection were most common. The majority of complications required one additional unplanned surgery for resolution. Two complications required abandonment of a growth-friendly strategy.
  
  
  CONCLUSIONS
  Use of VEPTR for TIS is associated with significant and frequent complications. C-EOS suggests that complications are more likely in those with normal or hyperkyphotic curves. Most complications are managed with one unplanned surgery. VEPTR is usually salvaged and abandonment of a growth-friendly strategy is unusual.
authors.affiliation: Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA. Electronic address: john.waldhausen@seattlechildrens.org.
authors.forename: John H T
authors.initials: JH
authors.lastname: Waldhausen
authors.affiliation: Division of Pulmonary Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
authors.forename: Greg
authors.initials: G
authors.lastname: Redding
authors.affiliation: Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
authors.forename: Klane
authors.initials: K
authors.lastname: White
authors.affiliation: Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
authors.forename: Kit
authors.initials: K
authors.lastname: Song
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012272:Ribs / Q000601:surgery; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D013577:Syndrome; D019616:Thoracic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D035441:Thoracic Wall / Q000002:abnormalities* / Q000601:surgery; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014025:Titanium
keywords: Chest wall reconstruction; Scoliosis; Thoracic insufficiency syndrome (TIS); Vertical expandable prosthetic titanium rib (VEPTR)