Pectus Bar For Surgeons.
Previously, surgical correction of this deformity was made through an invasive procedure requiring resection of cartilage and bone. It required four to six hours of operating time and could leave the patient with a more-rigid-than-normal chest. The Ravitch Procedure creates a blood loss of 300cc, whereas the Nuss Procedure has blood loss of only around 30cc or less. Dr. Donald Nuss, in cooperation with Biomet Microfixation, developed a minimally invasive surgical procedure and Pectus Bar Implant to remodel the chest wall over a two-to-three year period. The operating time for the Nuss Procedure is one to two hours, with an immediate visual fix of the deformity.
The Nuss Technique, also known as the "Minimally Invasive Repair of Pectus Excavatum" (MIRPE), uses principles of minimal-access surgery and thoracoscopy combined with the proper placement of a Biomet Microfixation Pectus Bar to achieve correction of pectus excavatum. The Nuss procedure does fix an asymmetric deformity; normally the surgeon will slightly bend the bar to overcorrect the more concave side. It is important that the bar is bent properly and that patients also work on breathing exercises a few weeks after surgery. While there is pain with this operation, most patients are back to normal activity in three to four weeks and back to some athletic activity after about two months. Dr. Nuss advises patients not to play any sports with swinging motions such as golf, tennis or wrestling, any of which could dislodge the bar. Most surgeons perform this surgery on children, teenagers and young adults; however, some surgeons are doing adult corrections as well with successful results.
- The Biomet Microfixation Pectus Bar's rounded ends and blunt edges discourage tissue destruction during implant insertion.
- The Pectus Bar comes in a variety of lengths, ranging from 7 inches (17.8cm) to 17 inches (43.2cm) to accommodate most pectus excavatum correction procedures.
- All instruments in the Biomet Microfixation Pectus System are designed to increase simplicity during the Nuss Procedure.
- The Pectus System Storage Container conveniently houses the entire range of Biomet Microfixation pectus implants and instruments.
Benefits Of The Nuss Technique
- Minimally invasive operation - Use of this technique requires neither cartilage incision nor resection for correction of pectus excavatum. There is no need to make an incision in the anterior chest wall, raise pectoralis muscle flaps, resect rib cartilages or perform sternal osteotomy.
- Reduced operating time - The procedure requires approximately forty minutes, as opposed to the four to six hours required for a chest reconstruction.
- Minimal blood loss - Blood loss is generally 10 to 30ccs, compared to the 300ccs lost with the standard products and techniques.
- Early return to regular activity - Reportedly, the average time for a patient to resume usual activities, once treated with the Biomet Microfixation Pectus Bar, is one month. However individual time frames may vary, based upon physician recommendations.
- Normal long-term chest correction - Using the Pectus Bar the patient can experience ease of breathing, normal chest expansion and elasticity, and proper lung and heart growth.
- Excellent Long-term cosmetic result - A 10 Year Study of a Minimally Invasive Technique for the Correction of Pectus Excavatum indicated excellent long term results. The Journal of Pediatric Surgery, 1998; 33(4). Donald Nuss, M.B., Ch.B.; Robert E. Kelly, Jr., M.D.; Daniel P. Croitoru, M.D.; Michael E. Katz, M.D.
Pectus Excavatum and other sternal deformities.
Patient Selection And Recommendations By Dr. Nuss.
- Patients with pectus excavatum are considered for surgical reconstruction between the ages of four and twenty years, when the ribs and costal cartilage are neither too malleable nor too rigid. The ideal age is between 6 and 12 years, prior to the adolescent growth period.
- For adults past the age 25 years, there may be more pain or complications involved; however, some surgeons focus solely on repairing adults' pectus deformities.
- Younger children should have the maturity and ability to follow the post-op restrictions on physical activity. Most younger children feel good within one week of coming home, but are unable to engage in physical activity for 6 weeks. This can be difficult to accomplish in an active, younger child that does not understand the consequences.
A complete physical exam and full medical history should be completed for all patients to place them into either asymptomatic or symptomatic classifications based on the following criteria:
- History of progressive worsening of the pectus excavatum.
- History of the symptoms related but not limited to exercise intolerance, chest pain and shortness of breath.
- Clinical evaluation showing severe pectus with the demonstration of cardiac displacement and pulmonary compromise.
- Asymptomatic patients are given an exercise program to correct their posture and are reevaluated every 6 months to follow their progress. Patients will be moved into the symptomatic group as indicated by their symptoms.
- Symptomatic patients are sent for a CT scan, pulmonary-function studies and cardiology examinations. Surgery is supported by the results of the objective criteria obtained from these exams. The criteria includes a CT index (Haller index) of 3.2 or greater, atelectasis, abnormal pulmonary function, cardiac compression, mitral valve prolapse, heart murmurs and A-V conduction delay. These patients may have other abnormalities, such as Marfan's syndrome, Ehlers-Danlos or Poland's syndrome.
- Prior to the day of surgery, the patient's chest is measured to determine the length of the Biomet Microfixation Pectus Bar. Proper measurement is performed utilizing a measuring tape or over the deepest portion of the pectus from the right midaxillary to the left midaxillary line. The length of the Pectus Bar required is 1cm to 2cm less than the measured distance because the tape measures the external diameter of the chest and the Pectus Bar traverses the internal diameter.
- The Pectus Bar templates are used to create the desired shape for the bent bar and can be used in surgery to compare the bend of the template to the bend of the actual bar.