Minimally invasive treatment of funnel chest

  The most common sternal deformities are funnel chest and chicken chest. Funnel chest, also known as concave chest, is a congenital thoracic deformity in which the lower part of the sternum is concave inward and the adjacent rib cartilage is also concave with it, forming a funnel-like appearance. The cause of funnel chest is unknown, but it is mostly a congenital developmental anomaly whose cause is not fully understood and is thought to be genetically related. Funnel chest is a progressive lesion that may be present at birth, but often becomes more pronounced after a few months or even years and is detected by parents. The external appearance is characterized by a sunken anterior chest, anterior shoulder extension, a slight hunch and a prominent epigastrium.  In severe cases, the sunken sternum of the funnel chest compresses the heart, lungs and other internal organs of the chest cavity, making the child prone to respiratory infections, poor motor tolerance, thin body shape, and a tendency to be quiet and immobile. In addition to the physiological effects on children with funnel chest, more importantly, it causes greater mental burden and psychological pressure on children and parents. These children are often ashamed to expose their front chest in public, afraid to wear tank tops in summer, afraid to go swimming in the pool, etc., and some even form psychological isolation.  Younger children with mild funnel chest do not need to be treated urgently because of the small impact on respiratory circulation, and may correct themselves with growth and development. For children with moderate and severe funnel chest, surgical treatment is recommended to correct the deformity, and generally children over 2 to 3 years old can tolerate surgery. and rib cartilage for this purpose. The initial approach was sternal reversal to a modified sternal reversal with preservation of blood vessels and muscle tips. The surgery required cutting or removing the deformed rib cartilage and sternum and then re-suturing it. This surgical procedure is complex, traumatic, hard on the patient, and has a high rate of postoperative complications and recurrence, and is increasingly unacceptable to patients and physicians. The Ravitch procedure simplifies the surgical operation compared to sternal reversal. The surgery requires excision of the rib cartilage that cuts off the deformity, while the sternum requires only a little oblique amputation. Post-operative complications are low and recurrence rates are reduced due to the somewhat shorter operation time.  ”Minimally invasive funnel chest orthopedic surgery” is a popular international treatment, which changes the traditional surgical method of opening the chest and cutting off the rib cartilage, with little trauma and without affecting the aesthetics, and has become the preferred method for saving funnel chest. Minimally invasive surgery, the Nuss method, has been developed in recent years. This surgical method is lightly traumatized, with quick recovery, early postoperative bed activity, few postoperative complications, high satisfaction rate of deformity correction, and low recurrence rate. Good results are also obtained in adults. It is a method worth adopting and promoting.  Nuss surgery is a minimally invasive surgery invented by American doctor Nuss in 1998. The main advantage of this surgery is that it does not require a large incision in front of the chest, no free chest wall muscle flap, no rib cartilage or sternum removal, so the operation time is shortened, less intraoperative bleeding and quick recovery after surgery. It has excellent cosmetic effect and can maintain the extension and flexibility of the chest for a long time. Because of its small trauma and satisfactory correction effect, it has been rapidly quoted by countries all over the world and become the most advanced “minimally invasive funnel chest correction” in the world.