There is a number of surgical methods available to correct the sunken chest wall deformity. Ravitch and the Nuss surgical procedures are two commonly used methods for treatment of pectus excavatum
Ravitch Surgical Procedure
The aim of Ravitch surgical method is the removal of abnormal rib connective tissues to allow the correct development of rib cartilage and reorientation of the sternum in an anatomical position.
In the traditional approach of Ravitch, a large incision is made across the chest to remove the excessive rib cartilage, reorient the rib bones in an anatomical position by implanting a wedge bone to correct the chest wall deformities. This procedure has been slightly revised as less invasive or modified Ravitch procedure.
During the modified Ravitch surgical procedure, a vertical incision is marked in the center of the chest for removal of excessive cartilage and later horizontal incision allows the sternum to bend forward. Stainless steels struts are used in the traditional surgical procedure of pectus excavatum to support the sternum in the new and exact position. These struts are invisible and remained intact within the body for at least two years to stabilize the new anatomical position. Recently, titanium plates are being used in teens and adults for stabilization of breastbone. There is no need for removal of titanium plates however they may needed to be checked for the possibility of pectus deformity recurrence
The Nuss Surgical Procedure
The minimally invasive Nuss surgical technique is an alternative Ravitch technique for the repair of chest wall deformity. The procedure is characterized by inserting an internal bracing without removal of the irregular connective tissues or cartilage via video-thoracoscopy surgery (VATs). The Nuss surgical procedure is mainly performed on adult patients.
During the procedure, small incisions are made on both sides of the chest and inserted a curved plate called Lorenz bar under the breastbone or sternum. A small part is incised to insert the camera called thoracoscope that helps the surgeons to visualize the deformity and tools to complete the procedure. The Lorenz pectus bar in collaboration of small grooved steel plate is inserted to fix the depression and to stabilize the new anatomical features. The concave shaped bar is placed inside for at least two years and removed after the required period of outpatient visit. This surgery takes around 3 to 4 hours to complete the procedure.
Silicone implant is a relatively new approach for correction of pectus excavatum. The procedure employs low hardness silicone plates to remove the chest wall deformity.