When is the best time to correct funnel chest surgery?

  1.Funnel chest is mainly judged by the appearance of the chest, and the formation of funnel chest is mostly caused by calcium deficiency.  2.Serious funnel chest will affect the child’s heart and lung function, resulting in poor mobility and poor physical fitness.  3.If the funnel chest is caused by calcium deficiency, we should check the calcium first, which can be determined by urine calcium and bone alkaline enzyme test, and then we should supplement calcium, what and how to supplement should be combined with your local doctor’s opinion.  4.Children with funnel chest will never disappear on their own when they grow up.  5, let the child more sunshine, can supplement the calcium absorption of vitamin D3, because the general infants are not really calcium deficiency, but lack of VD3, with sufficient VD3 can better absorb the calcium in milk, to play the purpose of calcium supplementation.  Funnel chest is a deformity in which the sternum, rib cartilage and part of the rib cage are sunken into the crest, shaped like a funnel and therefore called funnel chest. The anatomical changes are mostly from the 3rd rib cartilage to the 7th rib cartilage, which is recessed inward and deformed, with the deepest recess above the sternal process and the front end of the sternal process raised to the front. In severe cases, the deepest depression at the lower end of the sternum may be in contact with the crest, or even reach the side of the crest. In such a case, the mediastinal organs may be compressed and the heart may even be displaced to the right, resulting in cardiopulmonary dysfunction. According to the location of the funnel chest depression, the funnel chest can be divided into two types: left-right symmetric depression and asymmetric depression. Asymmetrical depressions are mostly deeper on the right side, with the ventral side of the sternal body turning to the right, or in severe cases, rotating 90° so that the ventral side of the sternal body becomes the left wall of the depression.  Treatment: The time for surgical correction of funnel chest is appropriate from 3 to 6 years old, and the deformity has the possibility of natural correction before the age of 3. However, foreign experts suggest that the best time for surgery should be chosen after the age of 6 to 8 years to avoid hindering thoracic development and affecting cardiopulmonary function due to extensive anterior thoracic surgery in early infancy. There is no limit to the maximum age, and it is best to operate before school age in terms of mental impact.  Orthopedic funnel chest surgery can be basically divided into two types: sternal lift and sternal reversal.  The two procedures have received mixed reviews. The characteristics of sternal lift are: cumbersome surgery, slightly poor deformity correction (especially in patients with combined heart deformity, the long-term effect is not good), postoperative abnormal whistling, long-term recurrence, small surgical trauma, suitable for the correction of symmetrical funnel chest in children; the characteristics of sternal reversal are: simple surgery, the most satisfactory deformity correction, no obvious postoperative abnormal whistling, no long-term recurrence, large surgical trauma, suitable for Children, adults or patients with recurrence of other surgical methods.  In 1998, Nuss proposed a less invasive approach by inserting a metal plate behind the depressed sternum to elevate the sternum without cutting the sternum and rib cartilage; in May 1999, Hideyoshi Sekiya combined the endoscopic technique with the above-mentioned Nuss method and obtained good results. It is characterized by no removal of rib cartilage and sternum, maintaining the extension, expansion, flexibility and elasticity of the thorax, and a concealed and beautiful surgical incision. However, the surgery requires special plates and is prone to problems such as plate slippage (displacement and flip). The procedure is more suitable for children aged 6 to 12 years old, while the postoperative results for older children and adults remain to be observed. Sternal reversal can be divided into two subcategories: sternal reversal without a tip and sternal reversal with a vascularized tip, which was used when we first performed funnel chest surgery in China in the 1970s. After nearly 10 years of clinical application, it was found that this operation was not suitable for children with small age and asymmetric deformity, and had complications such as large surgical blows and postoperative incision infection. Therefore, we started to adopt sternal reversal with vascular tip in the mid-1980s. In the past 10 years, we have routinely used the sternal reversal with vascular tip method and have experienced reliable fixation of the thoracic and rib cartilage with this method. Since the whole bone plate with intercostal muscles of the reversal maintains good blood supply, the postoperative recovery is fast and there is no risk of ischemic necrosis and infection of the sternum and rib cartilage. Patients can get out of bed on the third day and can be discharged after one week, with reliable long-term efficacy. Therefore, we believe that the sternal tipping method has more advantages and better results, and should be the first choice for the correction of funnel chest.