Funnel chest is a congenital thoracic deformity, mainly involving the anterior chest wall, with an incidence of 0.1% of newborns, most of whom are found to have a thoracic deformity at birth, which worsens with age and accelerates during adolescent development. The etiology of funnel chest is still unknown, probably due to the transitional unbalanced growth of the rib cartilage. Mild deformities without symptoms are followed up regularly. The disease has a tendency to worsen with growth, especially during the growth spurt, and can go from mild – severe within 6-12 months.
Age grouping for funnel chest surgery
Children <
Adolescents
Adults ＞
Indications for surgery.
Medical history, physical examination, chest CT, pulmonary function, cardiac function (EKG/cardiac ultrasound)
Clinical symptoms, severe deformity, or worsening of symptoms during follow-up
Chest CT shows: heart and lung compression, CT index R3.25 (for asymmetric funnel chest or flat chest, there may be errors in the use of CT index)
Heart compression or displacement with mitral valve prolapse with heart murmur, conduction system abnormalities, mitral valve prolapse in about 15-40% of patients with funnel chest, mitral valve prolapse disappears in half of patients after correction of funnel chest
Pulmonary function tests show restrictive or obstructive pulmonary ventilation dysfunction
Recurrent funnel chest
Thoracic orthoplasty or funnel chest with thoracic orthoplasty
Ask yourself or your family about any metal allergies before surgery; titanium is available for allergic patients.
Exercises for patients with funnel chest
Physical and form training for mild – moderate funnel chest
Objectives
Improve cardiopulmonary function
Improve body shape: funnel chest posture can aggravate funnel chest deformity
Increase the volume of the chest cavity
Stop the aggravation of mild deformity
Exercise to delay the progression of moderate to severe deformities and to give the patient the opportunity to operate at the optimal age (before development).
Exercise content
Breathing exercises
Form training
Various aerobic exercises
Swimming, running
-Reassessment in December
Postoperative exercises started after 6-8 weeks, same as above
Implant infection
Incidence <1%
Can be treated with oral long-acting antibiotics
Antibiotic therapy should not be discontinued until ESR and C-reactive protein return to normal
Usually no plate removal is required
Implant allergy
Postoperative metal allergy can be treated with oral prednisone in small doses until ESR and C-reactive protein return to normal
Factors affecting surgical outcome
Duration of plate placement
Recurrence is inversely proportional to the duration of plate placement
This difference is not significant
The recommended duration of plate placement is 3 years
Age
There is a higher chance of recurrence when the plate is removed before development, unless appropriate exercise is performed, the ideal age for correction is before development
The chest wall is elastic and malleable
Patients recover quickly and with less pain
The plate is in the body during growth and development, so recurrence is almost impossible
Postoperative recurrence rate is 5% (0-33%)
Causes.
Poor fixation of the plate (
early plate removal (<2 years), higher recurrence rate in children within 6 months of plate removal
’s syndrome
Re-operation
Mean age of initial surgery 9 years (1-19)
Recurrence: 7 years after Ravitch surgery
Immediately after surgery or after 14 months
Age at reoperation: 16 years (3-25)
Indication for surgery: all recurrences
Outcome: essentially the same as initial surgery