Surgical treatment of severe pectus carinatum in an adolescent patient (a clinical case report)



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Abstract

Backgruond. Pectus carinatum (keel-shaped deformity of the chest) is a deformity of the sternum and costal cartilages, representing the second most common type of chest wall deformity, with a prevalence ranging from 8% to 20% according to various authors. This study examines the clinical experience of using minimally invasive thoracoplasty for the correction of severe, rigid pectus carinatum.
Casedescription. A 17-year-old patient underwent surgical intervention due to severe pectus carinatum and the ineffectiveness of conservative treatment. The surgical procedure was performed using a minimally invasive technique with two T-shaped plates placed intra-/extrapleurally and ante-sternally.
Discussion. Correction of severe pectus carinatum deformity is often performed by surgeons using a radical approach, typically involving subchondral resection of deformed rib cartilage segments, sternal osteotomy and/or mobilization of the xiphoid process, resection of the lower end of the sternal body, followed by osteosynthesis. This approach carries risks of potential complications, including massive blood loss, subcutaneous hematomas, trophic skin disorders, instability of the sternocostal complex, and unsatisfactory cosmetic outcomes.
In the case of this patient, minimally invasive thoracoplasty was performed, which carries the same potential complications (arrhythmias, damage to major neurovascular structures, instability and migration of osteosynthesis implants) that are inherent to minimally invasive thoracoplasty for any type of sternocostal deformity.
Minimally invasive thoracoplasty offers several advantages over the radical correction technique, including reduced tissue trauma compared to extensive resections of the deformed rib complex, reliable stability of the sternocostal complex post-intervention, and improved cosmetic outcomes compared to submammary approaches in radical thoracoplasties, as well as superior aesthetic results.
Conclusion. Patients with severe pectus carinatum, particularly those with high-riding, rigid deformities, negative compression test results, and for whom conservative bracing therapy is ineffective or impossible, should be considered for minimally invasive surgical correction of the anterior chest wall deformity. The technique described in this study can be applied in the vast majority of cases requiring surgical correction of this deformity and demonstrates clear advantages over radical treatment methods.

About the authors

Dmitry V. Ryzhikov

Turner National Medical Research Center for Pediatric Traumatology and Orthopedics

Email: dryjikov@yahoo.com
ORCID iD: 0000-0002-7824-7412
SPIN-code: 7983-4270

MD, Cand. Sci. (Medicine), orthopedist-traumatologist

Russian Federation, St. Petersburg

Bahauddin H. Dolgiev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: dr-b@bk.ru
ORCID iD: 0000-0003-2184-5304
SPIN-code: 2348-4418

MD

Russian Federation, Saint Petersburg

Alevtina S. Tochilina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: astochilina@gmail.com
ORCID iD: 0009-0003-5378-5622

MD, PhD student

Russian Federation, Saint Petersburg

Sergey V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Anna V. Zaletina

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: omoturner@mail.ru
ORCID iD: 0000-0002-9838-2777
SPIN-code: 4955-1830

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

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