V.A. Markushin, R.Ya. Khayaliev, Sh.U.Rakhimy
1the clinic «Chalet-Sante» (Krasnodar, Russia).
2Multidisciplinary international clinic «Surgemed», Urgench, Uzbekistan
Background and Aim
Pectum excavatum (PE) and keel-shaped chest deformity are the most common chest deformities. Ravitch performed an advanced open intervention technique in 1949. In 1998, Nuss et al. presented a minimally invasive technique as an alternative to standard open plastic surgery, the so-called minimally invasive plastic surgery of funnel-shaped deformation or minimally invasive plastic surgery of funnel-shaped deformation of the chest.Our goal was to improve the results of surgical treatment of PE by a differentiated approach and optimization of tactics with the choice of an invasive or non-invasive method of correction, depending on the degree of deformation.
Method
2002 patients with PE were adjusted for the period 2019-2022. Of these, 156 patients were citizens of Uzbekistan. 250 (12.48%) patients underwent Nuss surgery — with a Haller index of more than 3.3-3.5; older age group (≥22 years); lack of efficacy from Vacuum Bell. MSCT allows to calculate the Haller index and provides information about the size and shape of the necessary corrective metal plate.
Results
In the early postoperative period, 13 (5.2%) patients had complications: pleurisy – 7 (2.8%), wound suppuration – 1 (0.4%), periimplantitis – 1 (0.4%), postoperative pneumonia – 3 (1.2%), plate detachment with displacement in 1 (0.4%) patient, in the latter case, a second operation was needed. No fatal cases were noted. Good results were observed in 237 (94.8%) patients. It should be noted that pleurisy is noted in 5% of patients older than 30 years.
view of chest before and after Nuss procedure
Conclusions
A competently performed Nuss operation gives not only good functional and cosmetic results in the form of improving the functioning of the cardiovascular and pulmonary systems due to the return of the physiological shape of the chest walls and diaphragm, but also improves the quality of life due to better psychological and social adaptation of the individual in society.
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