Kasagi Y, Wada J, Nakajima H, Irie T, Kondo K, Ikeda T
Nihon Kyobu Geka Gakkai Zasshi. 1989 Mar;37(3):540-5.
We performed surgical reconstruction on 1655 cases of deformed thoracic cage, we later operated again on 11 of these to repair postoperatively re-deformed anterior chest walls. Based on these experiences, we have concluded as follows. 1: Postoperative recurrence of funnel chest deforming is mainly due to insufficient resection of costal cartilages. In particular transection of the sternum at low levels during sternal turn-over procedure results in postoperative recurrence of depression in the upper anterior chest wall. 2: In young children who have undergone sternal turn-over procedure, the first and second costal bones and cartilages overgrow and protrude anteriorly, and in compensation their junctions to the sternum recess posteriorly. This results in a depression in the upper anterior chest wall. 3: We recommend sternal turn-over with overlapping of the sternum for repair of postoperative funnel chest deformity. Through this procedure, the extent of resection of costal cartilages can easily be determined and the depression of the anterior chest wall satisfactorily reconstructed. 4: In re-do surgery, we obtained pathological evidence confirming our clinical experience that our sternal turn-over technique does not interfere with blood circulation or development of the turned-over sternum even though the sternum is not connected to the rectus abdominus muscle pedicle, preserved internal mammary vessels, or anastomosis of the internal mammary vessels.
我们对1655例胸廓畸形患者进行了手术重建，之后又对其中11例患者进行了再次手术，以修复术后再次变形的前胸壁。基于这些经验，我们得出以下结论：1：漏斗胸畸形术后复发主要是由于肋软骨切除不足。特别是在胸骨翻转手术中低位切断胸骨会导致前胸壁上部术后凹陷复发。2：接受胸骨翻转手术的幼儿，第一、二肋骨及肋软骨过度生长并向前突出，作为代偿它们与胸骨的连接处向后凹陷。这导致前胸壁上部出现凹陷。3：我们建议采用胸骨重叠翻转术修复术后漏斗胸畸形。通过该手术，可以轻松确定肋软骨的切除范围，并令人满意地重建前胸壁凹陷。4：在再次手术中，我们获得了病理证据，证实了我们的临床经验，即尽管胸骨未与腹直肌蒂、保留的胸廓内血管或胸廓内血管吻合相连，但我们的胸骨翻转技术不会干扰翻转胸骨的血液循环或发育。
