Chapters Transcript Video Open Correction of Pectus Arcuatum Frazier Frantz, MD, presents a case of an 18-year-old male with pectus arcuatum. the patient is an 18 year old male who presented with typical physical exam findings of practice RQ. Autumn with horns of steer appearance. Sagittal cT images confirmed the presence of stirnemann oub real fusion. A vertical incision is fashion to allow access to the manu boreal region. The section is begun by creating full thickness flaps above the level of the pectorals and rectus fascia. After releasing the pectorals and rectus muscle attachments to the sternum and costal cartilage is rib resection is initiated. A sub pericardial technique is utilized to resect the ribs attached to the sternum at the proposed sites of manipulation. After costal cartilage resection is completed, attention is focused to sternal reconstruction. The typhoid is used as a handle to create a sub sternal plane using blunt dissection, the sternum is scored at the proposed sites of wedge osteo. To me, with the electric watery sternal Osti Autumn ease have been created through the interior table of the sternum at the site of wedge Osti ah To me using an oscillating saw. Austria tomes are then utilized to complete this. Wejust Iata me. The bone is debris did down to the level of the posterior table in preparation for creation of a green stick fracture through the posterior table. After Wejust Iata me and creation of fracture through the posterior table. There is improved flexibility of the sternum, which allows flattening to optimize the contour of the lower sternum. A second OsteO to me is scored with the electric watery, the oscillating saw is utilized to create a simple Osti. Ah To me at this site, the combination of the wedge Osti Autumn E. And simple osteo To me, has allowed complete flattening of the sternum with the sternum manually flattened preparations are made for external fixation. A sternal lock ladder plate is modified to optimum configuration for sternal fixation. This plate is secured across the wedge Osti Autumn E. Site using titanium screws, appropriate screw length can be determined by measurement on preoperative ct scanning or in the operative field by assessing the thickness of the sternum. During the process of screw placement, safety is optimized by placement of the surgeon's hand. Gauze pad or malleable retractor in the sub sternal space during plate fixation. At least four titanium screws are placed above and below the osteo to me site, to optimize stability. Additional titanium plating is utilized for sternal fixation at the site of the lower sternal osteo. To me, the screw placement technique is identical to the upper sternal fixation. A straight titanium plate has been placed for fixation of the left side of the sternum crushed bone fragments are placed in the osteo to me sites, wound closure has begun with re approximation of the pericardial sheaths. The rectus muscles are re attached to the lower sternum using a series of interrupted pds sutures to ensure stability. A Hema vac drain has been inserted and the short arm advanced into the sub sternal space. The picture Alice muscles are re approximated in the midline using a series of interrupted absorbable sutures. During this process, the majority of the underlying hardware will be covered by the pectorals muscles. The subcutaneous tissues and skin are closed in multiple layers. Postoperative chest X ray confirms appropriate positions of the external fixation hardware. The lateral view shows the reconstructed sternum with hardware in place. A preoperative picture of the chest wall prior to operation is demonstrated here. Examination of the chest wall, six weeks after open repair demonstrates a well heeled surgical incision, complete flattening of the sternum and regrowth of the resected costal cartilage is. Created by Related Presenters
