Pediatric Chest Wall Clinic

Pectus excavatum is when the sternum (breastbone) is pushed into the chest due to costal cartilage. The defect can apply pressure and displace the heart and lungs. Pectus excavatum correction surgery can be performed by pediatric thoracic surgeons, cardiothoracic surgeons and orthopedic surgeons. Treatment options include the suction bell, Ravitch (open) surgical repair, and the Nuss (minimally invasive) repair. The defect typically worsens during adolescent growth spurts and the defect is corrected after 11 years of age.

Pectus carinatum is when the sternum (breastbone) is pushed outward from the chest due to abnormal cartilage, causing a pigeon chest. The defect does not apply pressure to the heart or lungs. Carinatum defects can be treated non-invasively with bracing, or surgically. Defects present at the same age as pectus excavatum; we can offer bracing at most any age and surgery during adolescent years.

The Ravitch (open approach) and Nuss procedure (minimally invasive approach) are two surgical options. We also offer intraoperative cryoablation therapy (temporary freezing of nerves) for postoperative pain management, which allows most patients to be discharged 2 to 3 days after surgery. Postoperative activity will be tailored for each patient based on surgical approach and condition.

During the Ravitch procedure, the following steps are performed:

• An incision is made across the child’s chest
• The rib cartilage is reshaped
• One or more drains are placed under the skin to drain fluid from the surgery site
• A chest tube may be placed to prevent the lungs from collapsing before the incision is closed

In the months after surgery, the cartilage grows and keeps the breastbone in the new position.

Your child will need pain medicine and rest after the surgery. He or she will need to stay home from school until prescription pain medicine isn't needed.

For about six weeks after the surgery, your child should:

• Take all medicines as prescribed by the surgeon
• Do all breathing exercises (this helps prevent infection)
• Walk or do other gentle exercises as recommended by the surgeon
• Avoid gym class at school
• Not carry a backpack or other heavy items
• Avoid strenuous activity, including running
• Ride in the back seat to avoid possible trauma from an airbag in the event of an accident

During the Nuss procedure, the following steps are performed:

• The surgeon makes two small cuts on each side of the chest
• One or more bars are placed behind the breastbone and attached to the outer edge of the ribs; the surgeon will use a tiny camera to get the bars in the right place
• From there, the surgeon turns the bars, raising the breastbone
• A metal plate (called a stabilizer), sutures (stitches), or fiberwire will help hold the bars in place

The chest reshapes after 2 years, at which time the bars are typically removed as an outpatient procedure. Your child may return to normal activity, except contact sports, six weeks after surgery.

Even though the Nuss procedure is minimally invasive, your child will need pain medicine and rest after the surgery. He or she will need to stay home from school for about three weeks.

For about six weeks after the surgery, your child should:

• Do all breathing exercises (this helps prevent infection)
• Walk or do other gentle exercises as recommended by the surgeon
• Avoid strenuous activity, including running
• Ride in the back seat to avoid possible trauma from an airbag in the event of an accident

Your child should not play sports that could cause a chest injury (such as football, soccer and baseball) until the surgeon says it's OK.