Post-Ravitch Repair of Recurrent Pectus Excavatum with Minimally Invasive Anatomik Modelling Implant

The recurrence of pectus excavatum after open repair using the Ravitch technique has been reported to occur in 2–37 percent of instances (1). Pectus-UP, NUSS bar, and redo Ravitch have been reported as treatment options for patients requiring a second intervention (1). However, the optimal approach for redo surgery is still up for debate. 3D-printed, customized silicone implants offer a minimally invasive solution to correct the chest wall deficit.

The video illustrates the use of an Anatomik Modeling implant to correct a recurrent pectus excavatum with complications linked to previous surgery including nonunion of the sternum and chest wall. The patient and operative set-up is outlined in the video below.

The Case

A thirty-eight-year-old male presented with a pectus deformity and visible cardiac apex beat. Relevant background history included a previous Ravitch procedure with no other medical history. A computed tomography (CT) thorax demonstrated a Haller Index of 3.5:1. The scan was used to create a custom-made 3D silicone implant.

The sterile model was implanted under pectoral muscles via a 5 cm incision. Because of the patient's previous surgery, there was a large pocket anterior to the sternum. A four-layer polypropylene mesh was sutured to cover the chest wall defect overlying the heart. The mesh was meant to provide support for the chest wall and allow for stabilization of the implant to the mesh. Next, a 4 cm cut was made on the lower pole of the implant at its marked midline to straddle the intramuscular septum created by the superior aspects of the recti muscle insertions. The implant was invisible under the fascia and epigastric skin. Finally, LigaSure and argon were used as haemostatic devices to keep the wounds dry and limit seroma formation.

A negative pressure wound therapy device was worn for two days postoperation. The device limited the formation of a seroma. Postoperative care involved tapping of a seroma around the implant, and 80 milliliters were removed on day two for the patient prior to discharge. The patient wore a compressive vest for six weeks postoperation. Contact sports were contraindicated for three months.

Conclusion

3D printed implants provide good cosmetic outcomes for patients with pectus deformities, require short hospitalizations, and have few associated complications (2).

References

1. Kocher GJ, Gstrein N, Jaroszewski DE, Ewais MM, Schmid RA. Nuss procedure for repair of pectus excavatum after failed Ravitch procedure in adults: indications and caveats. J Thorac Dis. 2016;8(8):1981-5.
2. Chavoin JP, Grolleau JL, Moreno B, Brunello J, Andre A, Dahan M, et al. Correction of Pectus Excavatum by Custom-Made Silicone Implants: Contribution of Computer-Aided Design Reconstruction. A 20-Year Experience and 401 Cases. Plast Reconstr Surg. 2016;137(5):860e-71e.

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