Birth defects

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Chest Wall Deformities

  • Chest Wall Deformities

Description of disability:

These are when the bone of the chest or breastplate, does not form in the usual manner. A misshapen chest wall, or breastplate, can lead to compression of the heart and cardiovascular system. This can put undue stress on a child especially during physical activity.

Chest wall deformities, or abnormal development and appearance of the chest, can vary from mild to severe. These deformities are considered to be congenital and may be apparent at birth or later in childhood. Regardless, the severity of the deformity usually progresses rapidly during puberty. A variety of anomalies are described however the most common are pectus excavatum (sunken chest or funnel chest) or pectus carinatum (pigeon chest). Pectus excavatum is characterized by a depression in the sternum, typically the lower half of the sternum. This is a result of abnormal and unequal growth of the costal cartilages, that connect each rib to the sternum. Rather than growing flat along the chest wall, the costal cartilages grow posterior or toward the child's back. This pattern of growth pushes the sternum back, and prevents it from lying flat, giving the chest a sunken appearance. Pectus carinatum is characterized by a protrusion of the sternum that occurs as a result of an abnormal and unequal growth of the costal cartilage connecting the ribs to the sternum. Rather than growing flat along the chest wall, the costal cartilages grow outward pushing the sternum forward


In 1949, Ravitch reported a technique that formed the basis of modern pectus excavatum surgery. Through a midline incision over the defect, excision of all deformed cartilage from the perichondrium, division of the xiphoid from the sternum, division of the intercostals bundles from the sternum, and transverse sternal osteotomy were performed. The sternum was displaced anteriorly and held into position by using wires. a modified Ravitch repair. A proposed modification included developing a generous subcutaneous flap over the muscle fascia, thus greatly limiting the skin incision for both pectus excavatum and pectus carinatum (PC) correction procedures. A median of 4 sets of costal cartilage were removed in both subgroups. After that, a posterior sternal table osteotomy was performed, with placement of a triangular wedge of rib bone harvested from a lateral rib for stabilization. Asymmetry was dealt with by adjusting the angle of the posterior osteotomy.

Post operative care: 

Usual postoperative care with rest and immobilization is advised.


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