Purpose: This report describes the authors’ experience using a vacuum to pu ll the abnormal chest wall outward in patients with pectus excavatum. Methods: A suction cup was used to create a vacuum at the chest wall. ...Purpose: This report describes the authors’ experience using a vacuum to pu ll the abnormal chest wall outward in patients with pectus excavatum. Methods: A suction cup was used to create a vacuum at the chest wall. A patient- activate d hand pump was used to reduce pressure up to 15% below atmospheric pressure. The device was used by 60 patients (56 males, 4 females), aged 6.1 to 34.9 years (median, 14.8 years), for a minimum of 30 minutes, twice a day, up to 5 hours p er day (median, 90 minutes). Patient progress was documented using photography, radiography, and plaster casts of the defect. In 14 children this method was use d during the Nuss procedure to enlarge the retrosternal space for safer passage of the introducer. Results: Follow- up occurred between 2 and 18 months (median , 10 months). Computed tomographic scans showed that the device lifted the stern um and ribs within 1 to 2 minutes; this was confirmed thoracoscopically during t he Nuss procedure. The suction cup enlarged the retrosternal space for safer pas sage of the introducer. Initially, the sternum sank back after few minutes. Afte r 1 month, an elevation of 1 cm was noted in 85% of the patients. After 5 mont hs, the sternum was lifted to a normal level in 12 patients (20% ) when evaluat ed immediately after using the suction cup. All patients exhibited moderate subc utaneous hematoma, although the skin was not injured. One patient suffered from transient paresthesis in the right arm and leg. Two patients experienced orthost atic disturbances during the first application of the suction cup. There were no other complications. Discussion: In patients with pectus excavatum, application of a vacuum effectively pulled the depressed anterior chest wall forward. The i nitial results proved dramatic, although it is not yet known how much time is required for long- term correction. Conclusions: This vacuum me thod holds promise as a valuable adjunct treatment in both surgical and nonsurgi cal correction of pectus excavatum.展开更多
文摘Purpose: This report describes the authors’ experience using a vacuum to pu ll the abnormal chest wall outward in patients with pectus excavatum. Methods: A suction cup was used to create a vacuum at the chest wall. A patient- activate d hand pump was used to reduce pressure up to 15% below atmospheric pressure. The device was used by 60 patients (56 males, 4 females), aged 6.1 to 34.9 years (median, 14.8 years), for a minimum of 30 minutes, twice a day, up to 5 hours p er day (median, 90 minutes). Patient progress was documented using photography, radiography, and plaster casts of the defect. In 14 children this method was use d during the Nuss procedure to enlarge the retrosternal space for safer passage of the introducer. Results: Follow- up occurred between 2 and 18 months (median , 10 months). Computed tomographic scans showed that the device lifted the stern um and ribs within 1 to 2 minutes; this was confirmed thoracoscopically during t he Nuss procedure. The suction cup enlarged the retrosternal space for safer pas sage of the introducer. Initially, the sternum sank back after few minutes. Afte r 1 month, an elevation of 1 cm was noted in 85% of the patients. After 5 mont hs, the sternum was lifted to a normal level in 12 patients (20% ) when evaluat ed immediately after using the suction cup. All patients exhibited moderate subc utaneous hematoma, although the skin was not injured. One patient suffered from transient paresthesis in the right arm and leg. Two patients experienced orthost atic disturbances during the first application of the suction cup. There were no other complications. Discussion: In patients with pectus excavatum, application of a vacuum effectively pulled the depressed anterior chest wall forward. The i nitial results proved dramatic, although it is not yet known how much time is required for long- term correction. Conclusions: This vacuum me thod holds promise as a valuable adjunct treatment in both surgical and nonsurgi cal correction of pectus excavatum.
