1. What is Pectus Excavatum?
Definition: Pectus excavatum occurs due to the abnormal inward collapse of the rib cartilage and sternum (breastbone).
Symptoms:
Chest asymmetry or indentation.
Breathing difficulties.
Fatigue during exercise.
Heart palpitations or tightness.
Aesthetic concerns and low self-confidence.
2. Treatment Options for Pectus Excavatum
a) Non-Surgical Methods
1. Vacuum Therapy: A device creates negative pressure to help move the sternum outward.
Advantages: Does not require surgery.
Disadvantages: Requires prolonged use and may not be effective for all patients.
2. Braces and Exercises: Corsets and strengthening exercises aimed at improving posture can be applied.
Advantages: Non-invasive.
Disadvantages: Effective only in mild deformities.
b) Surgical Treatment Methods
1. Nuss Procedure:
Definition: A minimally invasive method where a metal bar is placed under the chest to reposition the sternum.
Advantages: Smaller incisions, shorter surgery times.
Disadvantages: A second surgery is required to remove the metal bar.
2. Ravitch Procedure:
Definition: A traditional open surgical method where the shape of the sternum and cartilage is corrected surgically.
Advantages: Effective for more complex deformities.
Disadvantages: Longer recovery periods and larger incisions are needed.
3. Preoperative Preparations
Physical Examination: The patient’s overall health and the severity of the deformity are evaluated.
Imaging Tests: Detailed imaging is performed using computed tomography (CT) and magnetic resonance imaging (MRI).
Functional Tests: Pulmonary function tests (PFT) and echocardiography may be conducted.
Psychological Support: Counseling services may be offered to address aesthetic and psychological concerns.
4. Postoperative Care and Rehabilitation
Hospital Stay: Typically 3-7 days.
Pain Management: Epidural anesthesia or pain relievers may be used.
Physical Activity:
Heavy physical activities should be avoided for the first two months post-surgery.
Light walking and breathing exercises are encouraged.
Long-Term Care: The metal bar is usually removed after 2-3 years (for the Nuss Procedure).
5. Risks and Complications
Infection: Risk of infection at the incision site.
Pneumothorax: Air leakage in the lungs.
Bar Displacement: Shifting of the metal bar.
Pain: Temporary or chronic chest pain.
6. Outcome and Quality of Life
Pectus excavatum surgery can provide both aesthetic and functional improvements, significantly enhancing the patient’s quality of life. Modern surgical techniques allow for better outcomes with less invasive methods. The decision for surgery should be tailored to the patient’s individual needs and the severity of the deformity.
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