Plastic and Reconstructive Microsurgery, Careggi Universital Hospital, Viale Giacomo Matteotti 42, 50132, Florence, Italy.
Department of Plastic and Reconstructive Surgery, University of Bari, Foggia, Italy.
Aesthetic Plast Surg. 2017 Aug;41(4):878-886. doi: 10.1007/s00266-017-0863-6. Epub 2017 Apr 3.
Pectus excavatum (PE) is one of the most frequent thoracic malformations. Generally, the malformation is not associated with functional disorders and often constitutes an aesthetic alteration with significant psychological distress.
To reduce the visibility of the residual scarring produced by corrective surgery and to improve the aesthetic outcome, the authors propose a new prosthetic implant technique through a periareolar access.
From January 2005 to January 2015, 11 patients affected with PE underwent the surgical procedure with a sternal prosthesis implanted through a periareolar access with the help of a fiberscope. The preoperative evaluation of the perception of the malformation and postoperation results were made using different questionnaires. The data collected in our series were compared with that reported in 4 different papers where other forms of access were used: sternal, inframammary and transumbilical.
No major complications or dislocation of the implants were reported. Among the complications, 6 postoperative seromas were reported. The patients' perception of improvement through the use of 2 questionnaires and an evaluation scale showed substantial improvement in all the aesthetic outcomes.
The periareolar technique provides excellent cosmetic results compared to the sternal one. This access causes fewer complications and necessitates a shorter average hospital stay than the sternum access. To conclude, according to what is shown in the literature, periareolar access seems to be a quicker procedure, requiring a shorter stay in hospital, and results in scars that can more easily be hidden and are more accepted by patients.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
漏斗胸（PE）是最常见的胸壁畸形之一。一般来说，这种畸形不会引起功能障碍，通常只是一种美观的改变，但会导致明显的心理困扰。
为了减少矫正手术后残留疤痕的可见度，并改善美观效果，作者提出了一种新的假体植入技术，通过乳晕入路进行。
自 2005 年 1 月至 2015 年 1 月，11 例漏斗胸患者接受了手术，通过乳晕入路植入胸骨假体，在纤维镜的帮助下进行。术前采用不同的问卷评估对畸形的感知，术后评估结果。我们的系列数据与另外 4 篇不同文献报告的数据进行了比较，这些文献采用了不同的入路：胸骨、乳晕下和脐部。
未报告重大并发症或假体移位。术后并发症包括 6 例血清肿。通过使用 2 个问卷和一个评估量表，患者对改善的感知显示，所有的美观结果都有显著改善。
乳晕入路与胸骨入路相比，提供了更好的美容效果。这种入路引起的并发症较少，平均住院时间也比胸骨入路短。总之，根据文献显示，乳晕入路似乎是一种更快的手术，需要住院时间更短，而且产生的疤痕更容易隐藏，也更容易被患者接受。
证据等级 IV：本杂志要求作者为每篇文章分配一个证据等级。有关这些循证医学等级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
