Conservative treatment of funnel chest
Physical therapy, breathing exercises, chest massage, physiotherapy, hyperbiric oxygenation, therapeutic swimming do not relieve the patient from chest deformity, but conservative measures must be carried out. In order to prevent the progression of deformity, strengthen the muscular frame and physical development of the child, prevent the development of spinal deformities, normalize posture, increase lung capacity.
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Surgical treatment of funnel chest
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Indications for surgery
Most orthopedists involved in thoracoplasty for funnel-shaped deformity of the chest adhere to the indications for surgical baking proposed by G. A. Bairov (1982). There are functional, orthopedic and cosmetic indications for surgical intervention.
- Functional indications are due to dysfunction of the internal organs of the chest cavity.
- Orthopedic indications are caused by the need to change the broken posture and curvature of the spine.
- Cosmetic indications are associated with the presence of a physical defect that violates the aesthetics of the physique.
Applying modern methods of examination and attaching great importance to the psychological status of the patient. A.V. Vinogradov (2005) suggested indications and contraindications for the surgical treatment of children with chest deformities, including post-traumatic and congenital defects.
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Absolute indications for surgery
- Funnel chest deformation of III and IV degree,
- Congenital and acquired deformities of the chest, which do not cause functional disorders in the respiratory and cardiovascular systems, but cause disturbances in the patient’s psychological status.
- Poland syndrome, accompanied by bone and cartilage defect of the chest and a decrease as a result of its frame and protective properties.
- Congenital crevices of the sternum in children of all age groups.
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Relative indications for surgery
- Chest deformities without defects of the bone and cartilage skeleton of the chest, causing neither functional nor psychological disorders.
- Acquired chest deformities after injuries, inflammatory diseases and surgical interventions.
Despite the simplicity and clarity of the indications for surgical treatment of the funnel chest, many orthopedic surgeons consider deformation of the II-III degree with the presence of functional disorders as the main indication for surgery.
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Contraindications for surgical treatment
- Severe concomitant pathology of the central nervous, cardiovascular and respiratory systems.
- Mental retardation moderate, severe and deep.
There are no clear recommendations on the age of patients who need thoracoplasty for funnel-shaped deformation of the breast cell. Basically, orthopedists provide data on surgical interventions in adolescents, citing this fact by the fact that young children do not reveal functional abnormalities. The funnel chest has serious functional impairments in pubertal and adolescence, since the high compensatory capabilities of the child’s body for a long time maintain the respiratory and cardiovascular functions that are close to normal. This circumstance often leads to an erroneous conclusion about the rejection of surgery in young children.
As the surgical treatment of patients with funnel chest deformity was improved, classifications by surgical treatment methods used so far have been proposed.
A convenient for practical application of operations for funnel chest deformation was proposed by V.I., Geraskin et al. 1986), dividing the methods of thoracoplasty and fixation of the sterno-rib complex into the following groups.
1. Radical surgery (thoracoplasty):
According to the method of mobilization of the sternum-ribs complex:
- subnasculator resection of deformed rib cartilage, transverse sternotomin;
- double chondrotomy, transverse sternotomy;
- lateral chondrotomy, T-shaped sternotomy
- combinations and other rare modifications.
According to the method of stabilization of the sternumfire complex;
- using external sternum traction;
- with the use of internal metal clamps;
- with the use of bone grafts;
- without the use of special fixators of the sternocore complex.
2. Operations with the rotation of the sternocore complex by 180:
- free revolution of the chest rim complex:
- a reversal of the colostrum complex with preservation of the upper vascular pedicle;
- coup of the medullary complex while maintaining connection with the abdominal muscles.
3. Palliative surgery:
There are three most common ways to mobilize the sterno-costal complex with a funnel chest.
- Subparticular resection of cartilage of the ribs, transverse sternotomy.
- Lateral chondrotomy, T-shaped sternotomy.
- Dual (parasgernadia and lateral) chondrotomy, transverse sternotomy.
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Postoperative complications of the funnel chest
The most frequent complications after thoracoplasty are hemothorax (20.2%), suppuration of the skin wound (7.8%), pneumothorax (6.2%), subcutaneous hematomas (: i, 7%), postoperative pneumonia (0.6%), pleurisy (0.9%). Along with the listed complications, without statistical clarification, mediastinitis, sepsis, osteomyelitis of the sternum, fixation migration, secondary bleeding, skin necrosis, intestinal paresis, hemopericarditis, pericarditis, myocarditis, keloid scars are isolated.
In the early postoperative period, for the timely detection of complications, hemodynamics, respiration, diuresis and the general condition of the patients are monitored. Usually, after recovering the patient's independent breathing, the patient is transferred to the intensive care unit, where symptomatic treatment of the funnel chest is carried out for 3-5 days. From the first day prescribed antibacterial treatment. Many surgeons consider the drainage of the retrosternal space with active Redon suction for 3 days to be mandatory. The chest cavity is drained with a polyethylene tube. After transferring the patient to a specialized department, a complex of therapeutic exercises and breathing exercises are prescribed in order to improve the function of the cardiorespiratory system. In the same period A.F., Krasnov and V.N. Stepnov according to a specially proposed method, apply hyperbaric oxygenation in combination with physiotherapy and electrical stimulation of the respiratory muscles.
Patients who have a funnel chest should be in the dispensary for a long time. Children after surgical interventions should be referred to health-improving treatment in a sanatorium.
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The effectiveness of the treatment funnel chest
The funnel chest after the operation is evaluated on the following scale: good, satisfactory and unsatisfactory.
- A good result is the absence of complaints about a cosmetic defect, the Gizyckoi (IG) index is 1.0, the complete restoration of the anatomical shape of the anterior chest wall.
- Satisfactory result - complaints of residual deformities of the anterior chest wall (slight depression or bulging of the sternum, local retraction of the ribs), IG is 0.8.
- Unsatisfactory result - complaints of a cosmetic defect, recurrence of deformity to the initial value, IG less than 0.7,
The most effective and objective assessment of various surgical interventions for funnel chest deformity is provided by Yu.I. Pozdnikin and I.A. Komolkin.
The authors for many years in the elimination of funnel chest deformity used four different surgical methods:
- thoracoplasty by GI Bairov;
- thoracoplasty by N.I. Kondrashin;
- thoracoplasty according to Paltia;
- tunnel chondrotomy (Pozdnikin Yu.I. And Komolkin IA).
Due to the significant efficacy and pathognomonicity, reconstructive combined musculoskeletal plasty of the chest should be included in the table of remote results of surgical treatment of patients with funnel chest deformity according to A.F. Krasnov and V.N. Stepnovu.
Reconstructive treatment of the funnel chest is an urgent problem of orthopedics and thoracic surgery. Foreign and domestic surgeons have proposed a significant number of fairly effective methods of surgical correction, combining the tendon-muscular plasty, bone graft, fixation of the sternocorbital complex with metal plates. Funnel chest should be treated by the method that will be optimal, taking into account the physiological state of the patient.