An Auxiliary Subxiphoid Incision in Nuss Procedure for the Treatment of Complex Pectus Excavatum.

An auxiliary subxiphoid incision was utilised to facilitate pectus bar placement and minimise operative risks in complex pectus excavatum. A series of 33 patients with recurrent or severe pectus excavatum underwent Nuss procedure with this incision from March 2013 to March 2016. The median age of the cohort was 6.9 years (9 females vs. 24 males). The mean Haller index was 5.22. There were 12 redo cases and 18 cases with a Haller index >6. Four cases underwent double bar correction. There was no perioperative death or major complication. Twenty-one cases had already the bars removed when this study was initiated. During follow-up (6-30 months), three cases presented with mild depression of lateral chest wall; while in the rest, the shapes of the chest wall remained satisfactory. The application of the auxiliary subxiphoid incision in Nuss procedure can make it safer in recurrent and severe pectus excavatum with favourable postoperative cosmetic effects.