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Pectus excavatum is a sunken spot in the center of a child's chest. It is caused by an overgrowth of cartilage as a baby's rib cage and breastbone (sternum) develop before birth. The cartilage is extra long and pushes the breastbone back into the body. The condition may not be noticed at birth. It is clearly apparent by the time a child is two or three and can get worse as the child grows up and goes into puberty.
Two Approaches to Correcting Pectus Excavatum
Two types of surgery can be used to treat pectus excavatum. Both types require a child to have a general anesthesia before the operation. The child then must stay in the hospital for four to six days after surgery.
The traditional approach to repairing pectus excavatum requires that an incision be made across the child's chest below the level of the nipples. The chest muscles must be raised from the breastbone and ribs. Part of the cartilage where the ribs join the breastbone is removed. A wedge of the breastbone is also removed. The breastbone is lift upward and a strut is inserted behind it to hold it forward during the healing process. When the cartilage and bone grow back, they grow in a more normal position.
Nuss repair is a minimally invasive approach to repairing pectus excavatum. In this type of surgery, two incisions are made on either side of the depressed area of the chest. A C-shaped metal strut is inserted behind the breastbone and in front of the heart. It is then rotated halfway around. This lifts the breastbone and bends the cartilage of the ribs to a more natural position. This approach may not be suitable for older adolescents or children with a lopsided sunken area.
Regardless of which approach is used, the child's vital signs are monitored throughout the surgery. Before the surgery, a breathing tube will be inserted after the child is asleep. Lines going into the veins may be inserted (IV lines). A catheter to drain the bladder may also be inserted.
After the surgery, the child goes to the recovery room. After an hour or two, he or she will be moved to the surgical floor. The child may have a small rubber tube under the incision to drain fluids that may collect. This will be removed in one to two days. The day after the surgery, the child will be helped to walk and encouraged to eat or drink, if he or she feels well enough to.
If there is pain, a variety of approaches can be used to manage it. The pain specialists at the Cedars-Sinai Pain Center are available 24 hours a day to help.
Care Following Pectus Excavatum Surgery
The child will need to come back to see the surgeon for a follow up visit two weeks after surgery. This is to make sure that the area is healing and that there are no problems. Until this visit, the child shouldn't go to gym class, do strenuous activities or play contact sports.
After surgery, the child should be monitored. If any of the following appear, the doctor should be called:
- A fever of 100.5 degrees or higher
- Blood or other fluids draining from the site of the surgery
- Redness or swelling around the wound
- Severe pain that doesn't get better with pain medicine
- Shortness of breath
These could be signs of infection or a complication.