Correction of pectus excavatum using a sternal elevator: preliminary report

Operative procedures to correct the deformity caused by pectus excavatum are generally based on eithersternal elevation or turnover. In either case, the operation is highly invasive. By considering the softness of the costal cartilages in early childhood, we have developed an endoscopically assisted procedure that applies external traction continuously in order to elevate the depressed sternum and costal cartilages. Since August 1993, we have performed this operation in 11 patients with pectus excavatum who ranged in age from 3 years 1 month to 28 years. The traction screws came loose spontaneously in two early cases. Augmentation transfer of a latissimus dorsi muscle flap and dermal fat grafting were subsequently performed in these two patients, respectively. We achieved an excellent cosmetic outcome in the other nine patients, with results similar to those achieved with the conventional operation. Our technique is a two-stage procedure and the patient is limited in performing daily activities while wearing the traction device. Despite this drawback it can achieve permanent correction of the deformity. Accordingly, this method should be considered when pectus excavatum is corrected surgically, particularly in infants and young children.