Survey of Indication and Results of Surgery in Patients with Chest Wall Deformity in Guilan Province

Introduction & There is a large spectrum of congenital chest wall deformities mostly including pectus and sternal defects. Most of these deformities have mental and physiological effects. Reconstruction of these deformities has minimal morbidity and mortality rate and if they are repaired mental and physiological problems will be solved. Present study has been done in order to evaluate symptom and the surgery indication of various types of deformities and their treatment and results.
In this descriptive study, 52 patients (38 men, 14 women) with thoracic deformity underwent reconstructive surgery in Razi and Aria hospitals. All patients except those with sternal cleft underwent CXR, CT scan, for diagnosis. Ravitch's technique was used in pectus cases; resection of rib was done for patients with prominent rib using pectoralis major muscle and mesh; and chondrotomy was performed on sternal cleft.
The mean age of the patient was 14.81±5.8 (range, 3 to30). The most common symptom was malformation, seen in 52 (%100) patients. From 52 patients, 32 (61.53%) of patients were pectusexcavatum, 10 (19.23%) were pectuscarinatum, 7 (13.4%) protrotion of ribs and 3 (5.7%) sternal cleft. In most of patients CXR was abnormal (73.68%). The severity of pectusexcavatum ranged from 3 to 5cm. For patients older than 15, two pins were used to fix sternum. Most patients had no surgery complications (8 pneumothorax, 4 pneumonia, 3 atelectasis and 2 bar infections). Surgery complications were mostly observed in patients older than 15. Two recurrences in PE and one in PC were happened. There was no mortality. Most of the patients had score of 6 out of 10 postoperative pains (42.3%). The score of pain was noticeably higher in older patients. Period of hospitalization ranged from 3 to 7 days. The period of hospitalization in patients older than 15 was noticeably more. Patients were followed up 2-6 years. 15(28.84%) of patients declared excellent level of satisfaction and the 35 (67.30%) stated good and 2(3.84%) didn’t have satisfaction.
Pectusexcavatum and pectuscarinatum and sternal cleft are better to be corrected in age of 8-12 years; because as patients get older the chance of complication, recurrence, and psychological problems increases. And NUSS operation must be teaching in the teaching hospital of university.