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Anger J, Alcalde RFV, de Campos JRM. The use of soft silicone solid implant molded intraoperatively for pectus excavatum surgical repair. EINSTEIN-SAO PAULO 2014; 12:186-90. [PMID: 25003924 PMCID: PMC4891161 DOI: 10.1590/s1679-45082014ao2919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/25/2014] [Indexed: 11/21/2022] Open
Abstract
Objective: To describe a new surgical technique to treat pectus excavatum utilizing low hardness solid silicone block that can be carved during the intraoperative period promoting a better aesthetic result. Methods: Between May 1994 and February 2013, 34 male patients presenting pectus excavatum were submitted to surgical repair with the use of low hardness solid silicone block, 10 to 30 Shore A. A block-shaped parallelepiped was used with height and base size coinciding with those of the bone defect. The block was carved intraoperatively according to the shape of the dissected space. The patients were followed for a minimum of 120 days postoperatively. The results and the complications were recorded. Results: From the 34 patients operated on, 28 were primary surgeries and 6 were secondary treatment, using other surgical techniques, bone or implant procedures. Postoperative complications included two case of hematomas and eight of seromas. It was necessary to remove the implant in one patient due to pain, and review surgery was performed in another to check prothesis dimensions. Two patients were submitted to fat grafting to improve the chest wall contour. The result was considered satisfactory in 33 patients. Conclusion: The procedure proved to be fast and effective. The results of carved silicone block were more effective for allowing a more refined contour as compared to custom made implants.
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Affiliation(s)
- Jaime Anger
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Wallmichrath J, Baumeister RG, Giunta RE, Holzbach T, Frick A. Correction of asymmetric pectus excavatum using a virtually designed silicone implant. Aesthetic Plast Surg 2014; 38:146-150. [PMID: 24310582 DOI: 10.1007/s00266-013-0244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 11/07/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND An extended asymmetric funnel chest deformity with the breast gland located in the thoracic mold can lead to a fictitious aplasia of the breast. The authors termed this condition "pseudo-Amazon syndrome" because the breast tissue and the pectoralis muscle are fully developed. METHODS This report presents a detailed technical approach to the fabrication of a precise-fitting custom-made silicone implant. The design of the implant was achieved using a computed tomography (CT) data set and rapid prototyping. The volumes of the "hidden" and the normal breasts measured preoperatively by processing the CT data were similar. These volumes were compared with the breast volumes measured by three-dimensional photography 4 years postoperatively to assess the predictability of the volume congruency. The silicone implant was surgically placed in the epicostal plane and extended almost over the right hemithorax. RESULTS The implantation was performed without the necessity of further trimming. Both the surgeon and the patient rated the aesthetic and functional long-term result as good in terms of symmetry and the possibility of exercise without restrictions. The final breast volume of the surgically treated side was 95 % of the volume of the normal contralateral breast. CONCLUSION The described method reduces the operation time and the operative trauma by primary implant fit. However, the method is rather elaborate and the production process is expensive. This in turn reduces the generation of proceeds to a minimum. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jens Wallmichrath
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | | | - Riccardo E Giunta
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Holzbach
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andreas Frick
- Department of Hand Surgery, Plastic Surgery, and Aesthetic Surgery, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
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Pectus excavatum reconstruction with silicone implants: long-term results and a review of the english-language literature. Ann Plast Surg 2009; 62:205-9. [PMID: 19158535 DOI: 10.1097/sap.0b013e31817d878c] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pectus excavatum, or funnel chest, is an anterior chest wall deformity, characterized by a depressed sternum. Frequently used techniques for pectus excavatum repair are extensive thoracic surgical corrections at a young age. At an adult age, custom-made silicone implants can be used as a less extensive surgical option. Thus far, there are only a limited number of reports in the English-language literature concerning this treatment modality. We evaluated our series of 16 patients treated with custom-made silicone implants, assessing complications, patient satisfaction, and aesthetic outcome. Seven patients (44%) had complications, mostly seroma formation (31%). Ten of 12 patients (83%), who were evaluated at the long-term, reported improved patient satisfaction and 9 of 13 patients (69%), in whom aesthetic results were assessed, had a good or excellent aesthetic outcome.Our study, combined with a review of the English-language literature, demonstrates that there is a place for custom-made silicone implants in the treatment of pectus excavatum, especially in less severe cases at an adult age. Preoperative counseling with emphasis on the likelihood of seroma formation is advocated.
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Pectoral Etching: A Method for Augmentation, Delineation, and Contouring the Thoracic Musculature in Men. Plast Reconstr Surg 2007; 120:2051-2055. [DOI: 10.1097/01.prs.0000287394.22375.2e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Horch RE, Stoelben E, Carbon R, Sultan AA, Bach AD, Kneser U. Pectus excavatum breast and chest deformity: indications for aesthetic plastic surgery versus thoracic surgery in a multicenter experience. Aesthetic Plast Surg 2006; 30:403-11. [PMID: 16779689 DOI: 10.1007/s00266-004-0138-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Breast and chest wall disfiguration attributable to a funnel chest is an aesthetically and sometimes functionally debilitating deformity requiring surgical correction. Whereas extensive and combined deformities of the ventral chest wall are classically corrected using a so-called minimally invasive repair of the pectus excavatum, a modified Ravitch repair, or the minimized Erlangen repair, plastic surgeons are mostly challenged with alloplastic implant corrections of mild funnel chests. The authors have introduced an endoscopic method for placement of customized implants to restore the visible and nonfunctionally disturbing deformation of mild funnel chests when only the sternal plate is involved. This study compared these different plastic surgical and thoracic surgical approaches in a multicenter experience to develop a clinical algorithm and to identify those patients not requiring bony correction but rather alloplastic endoscopic implant correction alone. METHODS Patients with deformed rib cages and sternal plates were treated with the Erlangen minimally invasive procedure or a modified Ravitch procedure. For deformities involving the sternal bones only, endoscopically assisted minimally invasive implantation of silastic implants was performed. RESULTS Between 1987 and 2003, 599 patients with a pectus excavatum deformity were treated surgically by the authors' group. Between 1999 and 2003, 515 patients underwent surgery using the Erlangen minimally invasive repair technique at Friedrich-Alexander University-Erlangen. In addition, 84 patients underwent surgery at the Freiburg University Medical Center. In the current series, 79 patients underwent surgery using the modified Ravitch method. The mean patient age was 20.5 years (range, 3-54 years), and the rate of postoperative relapses was 5%. The findings showed that 73% of the patients judged the aesthetic result as excellent to good, and 20% were satisfied. In contrast, only five patients were suitable for soft tissue augmentation only. Two of these patients in the initial period received custom implants presternally via classical transverse skin incisions, whereas three patients were treated with endoscopic customized implant tissue augmentation. CONCLUSION Whereas with combined deformity of the sternal plate and the rib cage, a modified Ravitch repair yields good results, the endoscopic soft tissue correction with customized implants helps to avoid unsightly scars, allows for safe hemostasis in the dissection pocket, and leads to enhanced patient satisfaction. In the case of major chest wall deformity with orthopedic and functional relevance, a combination of the minimally invasive procedures (e.g., endoscopic correction and Erlangen repair) seems to show both optimized cosmetic results and maximized functionality.
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Affiliation(s)
- Raymund E Horch
- Department of Plastic and Hand Surgery, Friedrich - Alexander-University, Erlangen-Nürnberg, Krankenhausstrasse 12, Erlangen, Germany.
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Valdatta L, Fidanza C, Thione A, Benedetta B, Reguzzoni M, Protasoni M. Experimental study in rats: does varying the hardness of a silicone implant affect the type of capsule that surrounds it? Plast Reconstr Surg 2006; 117:1076. [PMID: 16525345 DOI: 10.1097/01.prs.0000201315.21081.8d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
We describe a technique in which the breast implant capsule is used to fill localized depressions in the breast, including those under the nipple-areola complex. Capsules have been reported to persist long-term and their high vascularity renders them suitable for use as flaps.
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Affiliation(s)
- Danish Imran
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
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[Poland's syndrome: clinic series and thoraco-mammary reconstruction. Report of 27 cases]. ANN CHIR PLAST ESTH 2003; 48:54-66. [PMID: 12801545 DOI: 10.1016/s0294-1260(03)00008-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors evaluate the quality of thoraco-mammary reconstructions in Poland's syndrome. There was 34 patients in our serie, and 27 were operating between 1982 and 2001. There was 19 women and 8 men; the mean age was 19 years (9-40 years). Because of the clinical variability, the authors propose a classification of the malformation's importance in 3 degrees. In our serie, there is 35% of degree I, 53% of degree II and 12% of degree III. Each patient had an average of 2 general anaesthesias (1-6). For the first operation time, men had translation of the homolateral latissimus dorsi muscle flap in 25%, and a thoracic prosthese in 75%. Women had mammary prosthese in 50%, expansion prosthese in 20%, mammary prosthese and thoracic prosthese in 20%, muscle flap in 10%. The same person analysed the results in terms: good, middle or bad. The results are good in 67%, middle in 22%, poor in 11%. In degree 1, the results are always good; in degree II, they are good in 59%, middle in 29% and poor in 12%; in degree III, the results are good, middle and poor in 33%.
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Genç A, Mutaf O. Polytetrafluoroethylene bars in stabilizing the reconstructed sternum for pectus excavatum operations in children. Plast Reconstr Surg 2002; 110:54-7. [PMID: 12087231 DOI: 10.1097/00006534-200207000-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nine children with severe pectus excavatum deformity were operated on in the Department of Pediatric Surgery, Thoracic Unit, Ege University Faculty of Medicine, Izmir, Turkey. There were four boys and five girls, and the mean age at operation was 6.3 years. A modified Ravitch technique was performed by using two polytetrafluoroethylene bars placed retrosternally for fixation and stabilization of the reconstituted anterior chest wall. The bars were removed 6 months after the operation. Results were satisfactory in all cases, with no surgical complications.
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Affiliation(s)
- Abdülkadir Genç
- Department of Pediatric Surgery, Celal Bayar University, Manisa 45010, Turkey.
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Nordquist J, Svensson H, Johnsson M. Silastic implant for reconstruction of pectus excavatum: an update. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 2001; 35:65-9. [PMID: 11291352 DOI: 10.1080/02844310151032619] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Twenty-seven patients were operated on for pectus excavatum between 1985 and 1996 and had a custom-made subcutaneous Silastic implant inserted. We have reviewed their medical records to evaluate the clinical course, and used a questionnaire to assess the subjective outcome. There were no major surgical complications. Sixteen of the 27 patients reported improved appearance, and 11 would definitely recommend the operation to other patients under similar circumstances. Increased familiarity with the technique has led to implants with better size and shape, shorter hospital stay, and also to patients being more confident with the outcome. Augmentation with a custom-made Silastic implant is still a simple and straightforward way of concealing the deformity and alleviating the subjective discomfort in patients with pectus excavatum, whose cardiopulmonary function is within the normal range.
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Affiliation(s)
- J Nordquist
- Departments of Plastic and Reconstructive Surgery, Malmö University Hospital, Malmö, Sweden
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Hougaard G, Svensson H, Holmqvist KG. Casting the implant for reconstruction of pectus excavatum. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1995; 29:227-31. [PMID: 8539565 DOI: 10.3109/02844319509050131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fourteen patients with pectus excavatum underwent a total of 17 operations for the insertion of subcutaneous implants aimed at camouflaging their defects. A silicone prosthesis in one patient early in the series caused severe capsular formation. Although a block of Proplast may occasionally be used with success, the rational solution to the problem is to produce a custom made Silastic implant that adheres optimally to the defect in each individual case. This retrospective study shows that a subcutaneous implant clearly improves the appearance of the chest wall in most of the patients.
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Affiliation(s)
- G Hougaard
- Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Lund University, Sweden
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Bentz ML, Futrell JW. Improved chest wall fixation for correction of pectus excavatum. BRITISH JOURNAL OF PLASTIC SURGERY 1992; 45:367-70. [PMID: 1638289 DOI: 10.1016/0007-1226(92)90006-j] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pectus excavatum, the most common congenital chest wall abnormality, is manifested by deformity of the costal cartilages resulting in a depressed and often rotated sternum. Although there are conflicting data to support and reject the concept that physiologic improvement can be a consequence of surgical repair, correction is frequently indicated for aesthetic improvement alone. The most popular current repair involves resection of abnormal costal cartilages, sternal osteotomy and mobilisation, followed by fixation of the sternum in the corrected position. Improved fixation techniques have evolved, but generally have not employed current concepts of rigid fixation. The correction of pectus excavatum using reconstruction plates incorporates the benefits of rigid fixation, while allowing custom chest wall contouring and sternal reorientation. Reconstruction plate fixation of the sternum should be considered during correction of pectus excavatum in adult and adolescent patients.
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Affiliation(s)
- M L Bentz
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine
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