Problems related to removal of plates in minimally invasive funnel chest

  Parent’s question: “My son’s chest is getting better and better”. In fact, we have anticipated this problem. The minimally invasive funnel chest plate does not restrict the growth and development of the chest wall, and the shape of the chest will become more and more perfect during the natural growth and development of the chest. In addition, the support point of the plate is on the outside of the highest point of the bilateral ribs, and as the thorax develops and widens, the support point becomes closer to the highest point, which has a better effect on the lifting of the chest wall, so it is not difficult to explain this problem.  Problems when removing the plate: When removing the plate from a minimally invasive funnel chest, as long as the screws are unscrewed, the plate is lightly withdrawn, the fixation sheet is naturally separated from the plate, the plate is withdrawn, and the chest wall is not moved during the whole process of removing the plate, so the damage is minimal.  Theoretically, the minimally invasive funnel chest plate can be placed in the body for a longer period of time to ensure the efficacy because it does not restrict the growth and development of the thorax, but some special and unexpected cases have changed our thinking. For example, a 5-year-old boy had his plate removed six months after minimally invasive funnel chest surgery at an outside hospital due to plate allergy, but the chest wall was still erect at follow-up. In another case, an 8-year-old boy had a serious fall six months after surgery that resulted in the transverse breakage of two incisors and the displacement of the plate, but the chest wall was still intact, and he wanted to re-install the plate after removing it. There was also a case of an 18-year-old patient with large flat chest plus funnel chest in which the removal of the plate 17 months after surgery did not affect the surgical result at all.  This series of phenomena caused us to think deeply, and we repeatedly observed and thought about the postoperative chest X-ray images and chest appearance of the patient, and proposed the double-arc theory of ultra-minimally invasive funnel chest wall stability. In this way, the anterior chest wall after minimally invasive funnel chest surgery was topped into a longitudinal arc along the sternum and another transverse arc perpendicular to it, thus forming a very solid, non-sinking double-arc anterior chest wall with a more beautiful chest wall shape and a double-arc structure that could stabilize the anterior chest wall in a shorter period of time. The double-arc structure is likely to stabilize the anterior chest wall in a shorter period of time, so the possibility of postoperative recurrence is extremely small, and no recurrence after removal of the plate has been seen so far. Moreover, the time of plate removal can be greatly advanced. According to this theory, we propose that the time to remove the plate is about 1.5 years for growing children and about 2 years after puberty.