2.1. Minimally Invasive Sternal Depression Procedure

The patients laid in the supine position with both upper limbs abducted. A suitable type of steel bar was selected. The assistant pressed the protruding sternum until the desired height of the flat thorax was reached. Based on the shape of the chest at the time, the orthotic steel bar was bent into a bow shape. A 2.0 cm transverse incision was made at the midaxillary line on either side of the chest. The muscularis was dissociated to expose the ribs and intercostal muscles. The rib periosteum was dissociated. A steel wire was used to mount both ends of the Nuss bar stabilizer on the corresponding hard ribs and ensure that the stabilizers were parallel to the midaxillary lines. A tunnel was made at the subcutaneous tissue along the ribs and anterior to the sternum using a pair of long-curved tissue scissors. Damage to the pleura and stray into the thoracic cavity were avoided as far as possible. After the perforation of the tunnel anterior to the sternum, a chest tunneling tube with a pinhole was passed through the tunnel anterior to the sternum to the opposite side. The pinhole was retracted. The bent orthotic bar was inserted into the chest tube from one end and guided across the tunnel. The bar was then flipped over so that its back arch faced anteriorly. The sternum was pressed to a desired height, and a steel wire was used to fix both ends of the bar firmly with the stabilizers. The orthotic correction of the chest wall was completed (Figure 3).

Minimally invasive sternal depression procedure for pectus carinatum: (a) preoperative appearance, (b) postoperative appearance and the incision locations, (c) postoperative frontal chest X-ray film, and (d) postoperative lateral chest X-ray film.

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