In this section
Background and natural history
Pectus carinatum is a genetic disorder of the chest wall. It makes the chest push out. This happens because of an unusual growth of rib and breastbone (sternum) cartilage.
Pectus carinatum can often be treated with either:
- Ravitch procedure
Correction and recovery
For the vast majority of adolescent pectus carinatum, compressive bracing provides a cure. In partnership with our on-site orthotics company Hanger, Inc., custom braces can be designed at low cost and are adjusted or remade over time. Initial wear time for our patients is approximately 20 hours per day and this time can be decreased when the sternum is in the corrected position. Generally, patients continue to wear the brace to counteract the natural progression of the pectus carinatum as they grow taller, wearing it 12-16 hours per day. There are few types of brace, both static and dynamic, with slightly different appearances and higher cost in the dynamic side. We have found the outcome from both brace types to be outstanding. The most important factor for success patient motivation to wear the brace. For our families, this is an out of pocket expense ranging from under $1000 for a static brace and under $2000 for a dynamic brace, so time spent discussing with your adolescent before the purchase is well spent. Patients follow up with Hangar, Inc. as well as our clinic to document their progress during the 3 year period of correction. Our clinic has also worked with other orthotic companies as well in our more remote sites of care. The pictures the right show a static brace above and a dynamic brace below. The difference is in the presence of a bowed flexible surface pressing on the sternum in the case of the dynamic brace. Both braces achieve correction within 4-5 months, and in both brace types, the patient can choose how aggressively to correct by controlling the tightness of the straps. Braces can be worn under a T-shirt without being seen.
For patients requiring more than 5 pounds of pressure per square inch to correct the sternal position on physical exam, a compressive brace is inadequate. This situation is seen in only the most severe carinatum deformities in adolescents and in adult patients. Surgical correction using a Ravitch procedure can be completed with excellent results, even in patients with prior heart or chest surgery. Using either transverse incision below the nipples or one over the breastbone, the cartilages connecting the breastbone to the rib tips are removed where abnormal. This allows the breastbone to be moved into a corrected position, often supported by a strut or wire, and the cartilages regrow to fix the sternum into the new position. Recovery is often 3-5 days in hospital with 2 drains that are removed a few days after surgery. Wire or strut removal is completed 6-12 months after the initial surgery as a day surgery procedure. Contact sports are avoided until the chest wall becomes more rigid at 9-12 months postoperatively. The final appearance is the exchange of a pectus excavatum for a 10-12 cm incision over the front of the chest. In patients with mixed pectus excavatum/carinatum, a partial Ravitch approach may be completed with a Nuss procedure for optimal correction.
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