Historical perspective of surgical correction of pectus excavatum

In 1594 Johann Bauhinus describes a boy of 7 years previous affection of a deformity of the chest wall that had been presented at several family members. In 1938 Woillez also describes a concave chest in a medical journal of the Medical Society and in 1860 French is when you first used the word to describe a congenital funnel of a medical student named Johann Heinrich Wojaczek, also in one of these bulletins doctors, no author, whose depression could admit the head of a small child. Prior to these dates, we knew the existence of various types of malformations of the anterior chest wall, for various archaeological and paleontological studies, in which skeletons are described with different forms of malformations of the sternum, costal cartilages and the spine.

The first descriptions of pectus excavatum surgery date back to 1911 (Ludwin Meyer) and 1913 (Sauerbruch). Were advances in anesthetic techniques, which allowed for these surgeries, evidently with a high degree of morbidity and mortality, and indicated only in patients incapacitated by serious problems of dyspnea and palpitations. In 1920 Sauerbruch describes his technique of bilateral resection of deformed costal cartilages, sternal postoperative sternotomy and traction for 6 weeks.

This technique became popular for decades in Europe and America (I've met) and was the inspiration for his famous Ravitch described technique in 1949 and lasting, very well accepted by the scientific community. Previously, Ochsner and DeBakey in 1939 and also published in 1944 Sweet surgical techniques for correction of this deformity with a high morbidity and mortality. Lincoln Brown of San Francisco, published an interesting paper in 1939 on the section of the ligaments connecting the sternum to the diaphragm as a method to release deep rooted part of the sternum, falsely considering that this could be the cause of the deformity. This idea etiopathogenic persisted for decades.

From the description by Ravitch surgery, there have been several authors who have contributed various surgical alternatives to this surgery. Dorner (1950), Gross (1953), and Sulamaa Wallgren (1956), Baronofsky (1957) Welch (1959), Adkins and Blades (1961) Haller (1970). All these techniques emphasized the preservation of the perichondrium of the costal cartilages, sternotomy and sternal release of the rectus abdominis muscles, adding different forms of fixation sutures or metal bars retro Transsternal Dacron mesh, miniplates titanium or bioabsorbable materials. Wide resection of deformed costal cartilages young children leads to a stunting of the chest and can cause functional disorders of the respiratory movements limit and a restriction of lung capacity. This fact has been well described by Peña (1990) and Haller (1996). A novel intervention described by Judet in 1954, was to turn the once disinserted sternum the costal cartilages and performing a sternotomy malformed at the start of the funnel. This technique was very predicament in Japan by Wada in 1970 published a long series. The infection and sternal necrosis were their biggest disadvantage.

Of all these techniques described, many of which still continue in use, none is universally accepted as best practice. All are at risk of late recurrence from 2% to 20%, making it difficult to manage these patients.

Nuss in 1998 published his experience of 10 years to lift the sternum with a retrosternal bar introduced by two bilateral incisions, without resection or section of the costal cartilages or sternotomy, a minimally invasive technique performed by thoracoscopy. This technique, well-founded from the standpoint of behavior Sternal bone structure has been well accepted by the surgical community, therefore do not require bone resection, has minimal blood loss, short operative time, fewer complications, a very acceptable results and a very quick return to regular daily activity. Since its original presentation, several modifications have been made both in terms of technique, tools and methods of setting the bar substernal, which has substantially reduced the risks of surgery and complications.

Other techniques, also to take account of the defect are stuffed with silicone implants as (Allen 1979, Marks 1984), injections of various polymers (Pacine 2002, Heden 2007) and recently the suction bell (Schier 2006) and thoracic remodeling by magnetic devices (Jamshidi and Harrison 2007), methods still require further evaluation.

In Spain, there is little literature on this malformation, emphasizing the de Vega Díaz in 1961 and the work of Serrano Muñoz Jiménez Díaz Foundation in 1969 and 1982. In the field of pediatric surgery, highlighting the work of L. Bento in 1982, 1994, 1997 and 1999.

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