Horch Raymund E, Stoelben Erich, Carbon Roman, Sultan Alaa A, Bach Alexander D, Kneser Ulrich
Department of Plastic and Hand Surgery, Friedrich - Alexander-University, Erlangen-Nürnberg, Krankenhausstrasse 12, Erlangen, Germany.
Aesthetic Plast Surg. 2006 Jul-Aug;30(4):403-11. doi: 10.1007/s00266-004-0138-x.
Breast and chest wall disfiguration attributable to a funnel chest is an aesthetically and sometimes functionally debilitating deformity requiring surgical correction. Whereas extensive and combined deformities of the ventral chest wall are classically corrected using a so-called minimally invasive repair of the pectus excavatum, a modified Ravitch repair, or the minimized Erlangen repair, plastic surgeons are mostly challenged with alloplastic implant corrections of mild funnel chests. The authors have introduced an endoscopic method for placement of customized implants to restore the visible and nonfunctionally disturbing deformation of mild funnel chests when only the sternal plate is involved. This study compared these different plastic surgical and thoracic surgical approaches in a multicenter experience to develop a clinical algorithm and to identify those patients not requiring bony correction but rather alloplastic endoscopic implant correction alone.
Patients with deformed rib cages and sternal plates were treated with the Erlangen minimally invasive procedure or a modified Ravitch procedure. For deformities involving the sternal bones only, endoscopically assisted minimally invasive implantation of silastic implants was performed.
Between 1987 and 2003, 599 patients with a pectus excavatum deformity were treated surgically by the authors' group. Between 1999 and 2003, 515 patients underwent surgery using the Erlangen minimally invasive repair technique at Friedrich-Alexander University-Erlangen. In addition, 84 patients underwent surgery at the Freiburg University Medical Center. In the current series, 79 patients underwent surgery using the modified Ravitch method. The mean patient age was 20.5 years (range, 3-54 years), and the rate of postoperative relapses was 5%. The findings showed that 73% of the patients judged the aesthetic result as excellent to good, and 20% were satisfied. In contrast, only five patients were suitable for soft tissue augmentation only. Two of these patients in the initial period received custom implants presternally via classical transverse skin incisions, whereas three patients were treated with endoscopic customized implant tissue augmentation.
Whereas with combined deformity of the sternal plate and the rib cage, a modified Ravitch repair yields good results, the endoscopic soft tissue correction with customized implants helps to avoid unsightly scars, allows for safe hemostasis in the dissection pocket, and leads to enhanced patient satisfaction. In the case of major chest wall deformity with orthopedic and functional relevance, a combination of the minimally invasive procedures (e.g., endoscopic correction and Erlangen repair) seems to show both optimized cosmetic results and maximized functionality.
漏斗胸导致的乳房和胸壁畸形是一种在美学上有时在功能上也会造成损害的畸形，需要手术矫正。传统上，广泛且合并的前胸壁畸形采用所谓的微创漏斗胸修复术、改良的拉维奇修复术或简化的埃尔朗根修复术进行矫正，而整形外科医生大多面临轻度漏斗胸的异体植入物矫正挑战。作者引入了一种内窥镜方法来放置定制植入物，以恢复仅涉及胸骨板的轻度漏斗胸的可见且不影响功能的变形。本研究在多中心经验中比较了这些不同的整形外科和胸外科方法，以制定临床算法，并确定那些不需要进行骨性矫正而仅需异体内窥镜植入物矫正的患者。
对胸廓和胸骨板畸形的患者采用埃尔朗根微创手术或改良的拉维奇手术进行治疗。对于仅涉及胸骨的畸形，进行内窥镜辅助的硅橡胶植入物微创植入。
1987年至2003年期间，作者团队对599例漏斗胸畸形患者进行了手术治疗。1999年至2003年期间，515例患者在埃尔朗根弗里德里希 - 亚历山大大学采用埃尔朗根微创修复技术进行了手术。此外，84例患者在弗莱堡大学医学中心接受了手术。在本系列中，79例患者采用改良的拉维奇方法进行了手术。患者平均年龄为20.5岁（范围3至54岁），术后复发率为5%。结果显示，73%的患者认为美学效果为优至良，20%的患者表示满意。相比之下，只有5例患者仅适合软组织增强。其中2例患者在初始阶段通过经典的横向皮肤切口在胸骨前接受了定制植入物，而3例患者接受了内窥镜定制植入物组织增强治疗。
对于胸骨板和胸廓的合并畸形，改良的拉维奇修复术效果良好，而采用定制植入物的内窥镜软组织矫正有助于避免难看的疤痕，在解剖腔隙中实现安全止血，并提高患者满意度。对于具有骨科和功能相关性的严重胸壁畸形，微创方法（如内窥镜矫正和埃尔朗根修复）的联合应用似乎能实现优化的美容效果和最大化的功能。
