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Non-Surgical Treatment For Pectus Carinatum

 

Pectus Carinatum Orthosis

For non-surgical treatment Pectus Carinatum developed  mechanical systems, they are of different working principles and designs

We like the system, produced in Russia.

The system is available in two versions.

Orthotics, Spinal, Rigid Supports

  • Provides increased anterior/posterior  directed  corrective  compression forces
  • hard metal components, rigid form, size adjustment
  • compression presses only front and rear, does not act on the sides, which is very important
  • Washable foam pads increase patient comfort
  • Ratchet closure

Indications: Abnormal chest shape, protrusion of both the sternum (breast bone) and the cartilage portion of the ribs, bowed chest (Pigeon breast)

The system is made individually to order

The system is available in two versions.

With Electronic Load Meter

pectus carinatum orthosis with electronic load meter

 

Without Electronic Load Meter

Main material: Aluminium alloy, Foamed polymer

Warranty: 2 years

Detailed system description and photos you can download here.

You can print and discuss this document with your doctor.

To order a system, calculating the cost of manufacture and delivery, you need to download and print this document.

After scan or photograph the document, send the files from manufacturer. Please firstly fill the  contact form below . Your submision is going to redirect manufacturer.

 

 

 

There Are Ten Size Of Vacuum Bell

​Mini 1 Vacuum Bell - 110 mm, round

Vacuum bell 11 cm 110mm-1

Vacuum bell 11 cm 110mm-2

Vacuum bell 11 cm children's model

​Mini 2 Vacuum Bell - 125 mm, round

Vacuum bell children's model 125-1

Vacuum bell children's model 125-2

​Middle 1 Vacuum Bell - 140 mm, round

Vacuum-bell-14cm-140mm-1

Vacuum-bell-14cm-140mm-2

​Middle 2 Vacuum Bell - 160 mm, round

Vacuum-bell-16cm-16mm-1

Vacuum-bell-16cm-16mm-2

Vacuum-bell-16cm-16mm-3

​Middle 3 Vacuum Bell - 175 x195 mm, ellipse

Vacuum-bell-175x195-1

Vacuum-bell-175x195-2
Vacuum-bell-175x195-3

​Big 1 Vacuum Bell - 190 mm, round

Vacuum-bell-19cm-190mm-1

Vacuum-bell-19cm-190mm-2

Vacuum-bell-19cm-190mm-3

Large 2 Vacuum Bell with a place under the nipples - 210x260mm

Vacuum-bell-Pectus-Excavatum-210x260-1
Vacuum-bell-Pectus-Excavatum-210x260-2
Vacuum-bell-Pectus-Excavatum-210x260-3

Vacuum-bell-Pectus-Excavatum-210x260-4

Vacuum-bell-Pectus-Excavatum-210x260-5


Vacuum-bell-Pectus-Excavatum-210x260-6


Vacuum-bell-Pectus-Excavatum-210x260-7


Vacuum-bell-Pectus-Excavatum-210x260-8

Big 2 Vacuum Bell - 220 mm, round

Vacuum-bell-22cm-Pectus-Excavatum-1

Vacuum-bell-22cm-Pectus-Excavatum-2

Vacuum-bell-22cm-Pectus-Excavatum-3

Large 1 Vacuum Bell - 250mm, round

Vacuum-bell-25cm-Pectus-Excavatum-1

Vacuum-bell-25cm-Pectus-Excavatum-2

​Vacuum Bell Type Women (for breasts or for developed pectoral muscles)

Vacuum bell women Pectus Excavatum-1

Vacuum bell women Pectus Excavatum-2

Vacuum bell women Pectus Excavatum-3
Vacuum bell women Pectus Excavatum-4
Vacuum bell women Pectus Excavatum-5

 

What is Pectus Carinatum?

Pectus carinatum (or also called pigeon chest) is a condition that is not life-threatening. The breastbone is abnormally protruded outward, because of the rapid cartilage growth that is forcing the chest cavity outward. Mainly, the first symptoms are shown in the 11 or 12 years, and that this condition is diagnosed. But, also that doesn’t mean that the first symptoms can’t be shown earlier. Sometimes, they may be present from birth or in the early childhood.

It is more often to appear in boys, and also there is a possible heredity component. For most children, it is not dangerous. But sometimes it may cause few symptoms like difficulty breathing, asthma or some respiratory infections.

 

What causes pectus carinatum?

The exact cause of this condition is not known. Many doctors believe that is it caused by an issue that occurs between the connection of the ribs and the breastbone. They are guessing that the cartilage is growing faster than the bones. Due to this, the breastbone is pushed outward. Still, there are researches done in order to determinate the reason for the rapid growth of the cartilage.

 

What are the symptoms of pectus carinatum?

Most commonly this disorder is asymptomatic. This means that there are not any symptoms that may be noticeable and that may reveal the condition.

But in some cases, there might be some symptoms like

  • Asthma
  • Fatigue
  • Increased frequency of respiratory tract infections.
  • Difficulty breathing during physical activity
  • Rigidity of the chest wall with decreased lung compliance
  • Progressive emphysema

 

Types of Pectus Carinatum

This deformity can be classified in two ways:

  • Chondrogladiolar prominence (CG) and
  • Chondromanubrial prominence (CM).

The chondrogladiolar prominence pectus carinatum is more common, whether the other one – chondromanubrial prominence is really rear and difficult to treat.

People that are affected by chondrogladiolar prominence are having their middle and lower areas of the rib cage arch forward. It is easier to correct the ribs that are longer because they are more flexible. If the ribs are shorter, they are less flexible and harder to correct.

Chondromanubrial prominence pectus carinatus – CM is typically symmetrical and affects the upper rib. It is harder to fix this type of pectus carinatum because the ribs that are affected are shorter and less flexible.

Another type of classification of pectus carinatum is done by the cause and the time of onset. These kinds of classifications are:

  • Post-surgical – occurs when the sternum is operated and it doesn’t heal properly after the surgery or chest trauma
  • Congenital – the premature fusion of the chest cavity is present at birth
  • Idiopathic – this is the most common type of pectus carinatum, that mainly appears between the ages 11 and 15

 

When does the pectus carinatum become noticeable?

Pectus carinatum is diagnosed in roughly 1 per 1500 children. It happens more often in boys than it happens in girls. Usually, nothing is seen before the 11th or the 12th year. This doesn’t mean that is not occurring in younger kids, only the percentage of younger children is smaller.

The conditions get worse is the adolescence stage, when most of the symptoms are noticeable.

 

 

 

Are there any risk factors, and are there another medical complications that are related to pectus carinatum?

If there is a family history of this disorder or some other chest wall deformity, that increase the risk of getting pectus carinatum. Also, another factor that increases the risk is a connective tissue disorder like Marfan’s syndrome.

When diagnosed in infancy, it may also be seen with premature breastbone fusion and congenital heart disease. Pectus carinatum is also much more common in Caucasians than people of other races.

 

What is the long-term viewpoint?

Pectus carinatum is non-life-threatening. The majority of children who are diagnosed are having the ability to live normal lives. If the case is mild to moderate, there’s the possibility that no medical treatment will be necessary. For children who do require medical intervention, results can usually be visible within a short period of time.

 

How can be pectus carinatum diagnosed?

Pectus carinatum is mainly diagnosed by a physical examination. For further confirmation, a front and side chest X-ray is needed as part of the workup for this condition. Also, a CT scan and MRI scan may be asked in some cases.

If you are experiencing an irregular heartbeat, the doctor will ask you to do an electrocardiogram (EKG) or echocardiogram.

 

How is this deformity treated?

Exercising

 

In the past years, some researchers are done about the exercise being a potential treatment for pectus carinatum.  These exercises target the muscles surrounding the protruding area and decrease the appearance of the outward chest cavity.

Still, the solution hasn’t been found yet. Before choosing this type of method is really important to speak firstly with your doctor.

Bracing

Brace treatment does not require general anesthesia and surgery and does not leave an operative scar. The treatment is performed at an outpatient clinic. For the most accident of pectus carinatum, treatment may not be a necessity. The most frequent approach for mild to moderate cases that need to be treated is done with the usage of braces of the chest wall. This is done by custom fitting a circumferential external brace that puts sustained force on the most prominent portion of the sternum or cartilages in order to cause regression or flattening of the chest wall. You’ll need to wear the brace for at least eight hours in a day during a minimum period of six months. This semi-padded brace corrects the outward presence of the chest over time through consistent pressure to the cartilage. This constant pressure causes the cartilage to gradually reshape. This steadfast pressure suits the gristle to gradually refashion. The best result is obtained if you wear the brace for a minimum one year and if you are braced through adolescence. Success rates of 65-80 % and long-term outcomes with orthotic bracing alone are encouraging.
Prior to a brace being used, a doctor regulates the amount of pressure that will be prescribed to fix the issue on a case-by-case basis. Results are mainly noticeable within the first few months.

The improvement of pectus carinatum is documented by using a chest CT scan. However, considering that most patients are concerned about the cosmetic results, satisfaction can be a better tool to measure the clinical outcome.

For older patients that are experiencing more advanced level of pectus carinatum, bracing may not be effective and the next thing to be considered is the surgery.

The patients who have completed the treatment protocol, which the medical staff has recommended, showed satisfaction scores superior to that of those who did not complete the treatment.

 

  • Some of the most common questions about bracing that parents are asking:

 

  • What is pectus carinatum brace?

It’s a lightweight brace that’s custom-made for every child personally. It wraps around the chest and puts pressure on the front part of the chest that sticks out.

 

  • How does a pectus carinatum brace work?

It works similar to the teeth braces, a chest brace will push the breastbone back to the normal position that has to be obtained. Your child’s health care provider will see your child regularly and adjust the pressure of the brace so it can work but still be comfortable.

 

  • How long do kids need to wear a brace?

Most of the kids are wearing the brace for 6 months minimum to a year, though some need to wear it longer, depending on the degree of the deformity. They usually can remove it for sports, showering, and other activities, but usually must wear it for 8 hours a day or even longer (it is better to wear it as much longer as they are able to). You must your child wear the brace exactly as recommended by your healthcare provider. This will help your child get the best results from it.

 

  • Are there any problems with wearing the brace?

Usually, wearing the brace causes no problems. Occasionally, the skin under it can get a little red and irritated. This usually goes away on its own, but call your health care provider’s office if :

-The redness doesn’t go away within 30 minutes after taking off the brace. -Your child develops blisters, sores, or a rash under the brace.

 

  • Is bracing painful?

Some kids can experience a slight discomfort after having the brace pressure adjusted. If your child is uncomfortable and your health care provider says it’s OK, you can give acetaminophen (such as Tylenol® or a store brand) or ibuprofen (for example Advil®, Motrin®, or a store brand) as directed.

 

  • What if my kid is not feeling comfortable and won’t wear the brace?

Most kids are feeling comfortable with wearing their brace. Usually, the brace can’t be noticed under the shirt. But if your child feels uncomfortable, please try to understand it and help him with that. Be all the time together, work and speak together, exercise together to come up with solutions and incentives to get your child to wear the brace. And agree on the occasional “night off” for important events, like a dance or beach day.

Your care team is a resource — for you and your child. The doctors and the whole team are there to answer any questions that you have and help you and your child get through the challenges of bracing and achieve the best result. You must understand that wearing the braces is essential for your child. You may feel sorry, but be strong and make your child yo wear it every day.

 

What expectations should we have regarding the bracing treatment?

Recovery and success rates for both traditional methods of treatment, bracing and surgery, range from good to excellent. Bracing is the least invasive treatment and poses the smallest risk. The main side effect of using a brace is skin irritation. The success rate of the bracing method is higher at the children who are aged from 11-14 years. Older people are most likely to be exposed to have a surgery.

 

If the bracing treatment is not able to correct the deformity, what is the next thing to do?

The surgical treatment was used as a second-line treatment in patients who were noncompliant to the brace treatment. Surgery is only offered if the bracing is not giving the desired correction or if the patient has passed his puberty and the skeleton cannot respond to the bracing method.  Surgical repair (or also called Ravitch procedure) is done through a horizontal chest incision across the mid-chest. The abnormal costal cartilages are removed, preserving the lining that covers the outside of the cartilage, allowing the sternum to be pushed downward in a more normal position. The whole procedure is done in several hours.

In certain patients, a break in the sternum is done in order to allow the sternum to be positioned downward. Additionally, this is also done to keep the sternum in the desired position after the cartilages have been removed and the osteotomy (the break), a temporary metal chest strut (bar) may need to be placed.

 

What is the care in the hospital following surgery? 

The surgical repair of the pectus carinatum is a procedure that s really painful. How long will you have to stay in the hospital is determinate by the level of the pain that you will be experiencing.

  • Anesthesia Local anesthesia is used and given through an epidural catheter that is placed in the child’s back during the surgery. The catheter might stay in place for few days after the surgery. Also, a urinary catheter will be placed in order to drain the urine from the bladder. Another catheter – intravenous will be placed and fluid and medications will be given through it. When the doctor will assume that all of these catheters are not needed anymore, they will all be taken away.

 

  • The day after the surgery– Getting from bad is usually required the day after the surgery. The patient will need to practice deep breathing as well, in order to keep the lungs healthy and to prevent pneumonia.

 

  • Constipation This is one of the most common things that children on medications are experiencing.

 

  • Leaving the hospital Once when the children are feeling comfortable, and they are able to eat and walk on their own, they will be released from the hospital. Also, their infection and fever must be gone away. The drain may still stay, but the family will be taught how to manage it at home.

 

  • Homecare– Children must do controls in the first year after the surgery. The chest strut is expected to stay in place for 2-3 years.
  • A shower can be taken 5 days after surgery. Have your child take the film dressing off before the shower and leave the tape strips in place. These will fall off on their own.
  • There are no stitches to be removed. These are under the skin and dissolvable.
  • Narcotic pain management may be required for up to one month after surgery.
  • Constipation is a common problem, and daily use of laxatives while on narcotics is recommended.
  • Redness or swelling of the incision(s) should be reported as soon as noted.
  • If your child is discharged with a drain in place, it will be removed in the surgical office when the draining had stopped.
  • Sports may be resumed as soon as the surgeon determines this is safe.

 

 

What type of activity is obligatory after the surgery?

 

Postoperative patients may report decreased exercise tolerance and exceptional dyspnea that may be the main factor to lower the activity tolerance. The improvement of these symptoms will begin to be noticeable between the third and the sixth month after the surgery. In the meantime, some postoperative activities are recommended, such as:

 

  • Use incentive spirometer and further periodic deep breaths.
  • Limit the twisting movements of the chest for at least 4 months after the surgery.
  • Skip some rapid elevation of the arms overhead for at least 4 months postoperatively.
  • Encourage lower extremity exercise (may begin within the second week after surgery).
  • Lightweights may be used to strengthen biceps and deltoids; the use of chest and abdominal muscles may be increased later (after the third to fourth week).
  • Gym classes are not recommended for 5 months after surgery in school-aged children.
  • Long-term recommendations include stretching exercises that involve pulling the shoulder blades posterior to improve posture.

 

 

  • Sources used:

 

 

 

What is pectus excavatum?

Pectus excavatum is a condition characterized by abnormal growth of the chest where several ribs and the sternum are caved in, producing a concave anterior chest wall. This condition is also called as “funnel chest” or sunken chest”. It is a congenital condition, presented in birth, and later in life may be developed in different directions (it may get lenient or serious). It is mainly followed by pectus carinatum.

It is estimated that there is one case with pectus excavatum in every 300-400 births.

pectus excavatum

What is the cause of pectus excavatum?

The exact cause of pectus excavatum is not known yet. According to the latest researches, specialist believes that it is caused by abnormal and not able to be controlled growth of the connective tissue that is connecting the ribs to the breastbone. Also, it is believed that is inherited conditions because there are cases when this deformity is run in the family from generation to generation.

pectus excavatum deformity

What are the symptoms of pectus excavatum?

For the majority of people, the only sign of pectus excavatum is the concavity in their chest. In the beginning, the indentation may be small, but later in the early adolescence it may get bigger and cause more serious complications.

There are cases that are showing other symptoms, along with the indentation of the chest. Some people are experiencing:

  • Chest pain
  • Fasten heart biting
  • Coughing
  • Fatigue
  • Respiratory infections
  • Shortness of breath

    Are there any risk factors that are increasing the chance to have pectus excavatum?

According to the studies, pectus excavatum is a more common condition in boys than in girls. Also, this                         condition  occurs more in people that are having:

  • Marfan syndrome
  • Turner syndrome
  • Ehlers-Danlos syndrome
  • Noonan syndrome
  • Osteogenesis imperfect
  • Rickets

What are the complications caused by pectus excavatum?

The main complications are related to the heart and lungs or with the person’s self-esteem.

The abnormal growth and the concavity of the chest may compress the heart and the lungs, or change the position of the heart to the other side. There may be less room for the lung to expand while breathing,

Self-esteem related problems are very often, especially between the kids that are having this condition. They are frustrated by their look and appearance, so they lack themselves from many social activities, especially the activities such as swimming.

How can be this deformity diagnosed?

Setting the diagnose pectus excavatum is very simple. The diagnosis is done by a simple physical examination of the chest. After that, the doctor may tell you to do several other tests in order to see if there are any additional complications with your heart and lungs. The additional tests that are done are:

  • Physical (stress) test – shows the function of the heart and the lungs while exercising, Usual it is done on a bike
  • Pulmonary function test – This test measure the amount the air in the lungs, and how fast the lungs can be emptied.
  • CT (computed tomography) on the chest – the CT scan produces cross-sectional images of the internal structure of the body, shown in different angles. Shows whether the organs in the thorax are compressed.
  • Chest X-ray – With this ray doctors are able to see if the heart is placed on the left side of the chest. Also, visualization of the dip is possible with the chest X-ray.
  • Laboratory work (blood test) – a Blood sample is taken in order to check the blood status for a diagnose.
  • Test for chromosomes and enzyme status
  • Metabolic studies
  • EKG (Electrocardiogram) – With the help of EKG, doctors are able to see whether the rhythm of the heart is normal or irregular, and investigate the electric signals of the heartbeat.
  • Echocardiogram – It is a sonogram of the heart. Real images show how the heart is working, how well the heart is and the proper working of the valves. Transmitting sound waves are producing the images.

Who Should Consider Treatment?

You can’t prevent pectus excavatum, but you may treat it. In the most of the cases, pectus excavatum is visible by the person’s physical appearance. But, also there are some symptoms that may indicate pectus excavatum, like:

  • Shortness of breath
  • Pain in the chest region
  • Irregular heartbeat
  • Decreased stamina

Also, another common symptom is the embarrassment from the physical appearance. People are having self-esteem problems that may cause depression as well. Help from a psychologist or psychiatrist Is essential.

What are the possible treatments for pectus excavatum?

For the most of the patients that don’t have symptoms, treatment is not needed. After showing some symptoms, they may consider getting a treatment.

There are some options for treatment two of them surgery ( The Nuss Procedure, Modified Ravitch Technique) other conservative treatment ( vacuum bell treatment).

Upon the young children, physical therapy is the most commonly considered type of treatment. During the young ages, physical therapy is considered because it may still reverse some of the deformity of the chest wall.

For the people that are having more than eighteen years, surgery may be considered, especially if the deformity is causing problems to the heart and to the lungs. The statistic data were taken in the last years show that the surgery can improve the function of the heart, of the blood vessels and of the lungs significantly.

The most important goal of the surgery is to improve the chest deformity, and with that to improve the patient’s health condition.

There are two types of surgeries that are commonly used as a treatment. The main difference between them is whether the cartilage is removed or nor, and the size of the incisions.

The Nuss Procedure:

The Nuss Procedure is mainly for the young children, and not advised for the older people. Surgeons use VATS – video-assisted thoracoscopic surgery to repair the pectus excavatum.   

It is mostly recommended for children because they have a soft chest. The anterior chest wall is quite malleable. In this technique, a stainless steel bar (known as Lorenz Pectus Bar) is placed under the sternum through a previous small incision made in order to correct the condition known as funnel chest. This method includes minimally invasive incisions, and at the same time, it is helped by thoracoscope for guidance.

The length of the bar is determined by measuring the line that connects the two midaxillary regions. From the obtained length, 1 cm is a substrate and that is how the perfect length of the stainless steel bar is determined. Typically, 1 hour before the surgery, a first generation cephalosporine antibiotic – cefazolin is given to the patient.

Also, before the surgery, generally endotracheal anesthesia combined with a thoracic epidural is given. The epidural catheter is left up to 3 days after the surgery. Although it is a minimally invasive, patients will experience postoperative pain and discomfort. This is due to the manding of the cartilages with the sternum, made my force.

The bar is not visible from the outside and stays in the same place approximately for two years. After that, when it is no longer needed, the bar is removed.

nuss procedure

 

Modified Ravitch Technique:

The Modified Ravitch technique is done by a long incision across the chest. The excessed cartilage is cut out, then the rib bones are repositioned and a wedge bone is implanted.

The patient is positioned with this birth hands abducted to the shoulders in order to provide a better access to the lateral walls of the thorax. The left and the right intercostal spaces are marked, and it shows the place where the bar will be inserted. As well, the points of the pectus ridge are marked that are showing the horizontal plane from the deepest point of the pectus to the lateral chest wall incisions.

The length of the bar is measured as a line that connects both mid-axillary points. It is bent from the center to each end. The shape of the bar is customized to fit every patient’s chest wall, so the curvature depends on the patient’s chest.

A 2 cm transverse surgical cut on the skin is made on the midaxillary line, on the right, and on the left side. With this, a skin tunnel is obtained anteriorly from the incisions to the top of the pectus ridge. This will allow the pectus bar to hug the wall of the thorax posteriorly.

In this procedure, a thoracoscope is inserted, 1 or 2 intercostal spaces below the space where the bar was inserted. With this, a great visualization is provided.  A vascular clamp is inserted through the right intercostal space.

The sternum is lifted by force as the instrument is passing to the contralateral side. During this whole procedure, the heart is monitored all the time in order to be sure that the instrument is not anywhere near the heart.

When the instrument is inserted on the contralateral side, the tip is pushed through the intercostal space and got out through the left skin incision.

If the Lorenz bar is inserted, then no further dilating will be needed. If the Crawford clamp is inserted, then the tunnel space will be enlarged. They come in different sizes: shorter for kids and larger for adults.

After the placement of the bar, the stability of the bar is crucial. A stabilizer is put, in order to prevent the rotation of the bar in the chest, and it joins the bar and the chest muscles. One stabilizer on each side is required usually for younger kids, and more stabilizers are put to the adults.

The epidural catheter is removed on the third day after the operation.

The patient is extubated deeply in order to prevent any movement that may move and relocate the bar. The patient will experience the strongest pain the first three days, and after that, the intensity of the pain will be minimized. For this purpose, the patient is under sedatives in the first three days. Therapy is individual for every patient, depending on his response to the pain. Extra help is required for the patient in the first three days when getting up from the bed and for eating.

The average hospital stay lasts up to 7 days, and the patient is released from the hospital when he/she it will be able to walk on its own.

The bar stays for two years maximum, and then it is removed in a procedure under anesthesia.

The Modified Ravitch technique is requiring much shorter operating time, less blood loss and a minimal scar on the anterior chest. The stability of the chest wall is not compromised. Also, with this procedure, the “thoracic construction” complication does not seem to occur. This complication is characterized by affected bone growth center and restriction of the chest wall is occurring that leads to a marked limitation of ventilatory function. The expiratory volume is decreased and that patient cannot do running physical activities. With MIRPE, such a complication is not a problem. With this procedure, the pulmonary function is normal and improved.

The ideal age for this surgery is between 5-12 years, while the chest wall is still growing. But, this technique was used in the adult patients with huge success as well, which means that is not per limited age only.

Conservative  Treatment With Vacuum Bell:

Vacuum bell is a conservative, special treatment for correcting pectus excavatum. It was discovered 10 years ago, as an alternative option to the surgical treatment. The vacuum bell, with the help of hand pump, creates a vacuum at the anterior chest wall. There are different sizes of vacuum bell available, depending on the patient’s age and size. This device can be used at home, twice a week and several hours per day. When the vacuum is created, the sternum is lifted together with the ribs and stays in that position for some time. The long-lasting results from this treatment are showing remarkable effects and success. For now, there aren’t any side effects noticed. You can buy vacuum bell trough our website.

 

What Are the Benefits Of Surgery:

Most of the people that have decided to undergo surgery are happy and satisfied with the obtained result. The best results are gained if the surgery is made during the young ages of the patient when the bones and the cartilages are still growing and developing, but this doesn’t mean that the adults don’t have benefits from this surgery too.

The primary goal of the surgery is to reduce the compression of the heart and lungs. It is expected that if the patient is going to get appropriate recovery, the endurance of the patient and the physical activity and exercise tolerance will be improved.

Are there any possible risks from the surgery and if there are, what are they?

Like any other procedure, this procedure also is presenting certain risks. Both procedures are safe and done with advanced instruments, still, there may be several complications.

Possible complications that may occur during the pectus excavatum surgery are the followings:

  • Infection
  • Bleeding
  • Pneumothorax
  • Bar displacement and erosion through the skin
  • Pleural effusion
  • Pectus excavatum recurrence

Before doing the surgery, a consultation with a cardiologist and pulmonologist are required. They are really important for the procedure, as well as if the insurance companies don’t want to cover the operation.

According to recent studies, mainly the complications are more common for the younger patients, especially the bar displacement. Because of this, a third fixation technique was obtained in order to provide additional support. The results are good and improved so that the MIRPE operation is done successfully in a much older patient without complications.

Consultation with a physical therapist after the operation is important for better recovery from the surgery. The physical therapist is giving special instructions for exercises that are mandatory during the recovery period. Physical therapy should last around two months when the patient is no longer experiencing any kind of pain and it is prepared to start with the normal everyday routines.

Is there any special diet required?:

Because of the narcotics and all the sedatives that are used during the whole procedure, constipation is a common effect. Due to this, a high-fiber diet and laxatives are recommended for a few days after the surgery. Some other dietary restrictions are not required.

Activities after the surgery:

Patients must avoid banding of the hip for the first month. Also, lifting heavy things is not permitted in the first month. In the first three months, except the exercises and the activities that are recommended by the doctor, other sports are strongly forbidden. After three months, they may start doing some sports, but to take care not to get hurt. Patients will be able to do normal activities after the removal of the bar, which is usually after two to three years after the repair of the pectus excavatum.

 

Sources used:

 

The vacuum method was used as early as 1910 by Lange. A vacuum bell is a plastic device that is connected to a pump. You place the bell-shaped device on the front of the chest and use a pump to suck the air out of the device. This creates a vacuum that pulls the chest forward. Over time, the chest wall stays forward on its own. Three different sizes of vacuum bells, as well as a model fitted for young women, exist. The appropriate size is selected according to the individual patient’s age and ventral surface. The device should be used at home for a minimum of 30 minutes (twice a day) and may be used up to a maximum of several hours daily. The intensity of the applied negative pressure can be evaluated with an integrated pressure gauge during follow-up visits. A prototype of an electronic model enables us to measure the correlation between the applied negative pressure and the elevation of the anterior chest wall.

vacuum bell for pectus

In many cases of Pectus excavatum, the degree of pectus deformity does not immediately warrant surgery, yet patients may benefit from some type of nonsurgical treatment.

The lifting of the funnel involves a 3-part process affecting the bones, cartilages, and ligaments of the ribcage:

  • an initial, reversible (elastic) deformation;
  • a gradual, permanent transformation;
  • and micro-ruptures, most likely occurring at the beginning of the treatment (until these ruptures heal, the patient?s ribcage will experience a slight temporary loss of firmness).

The funnel’s return to its concave position upon removal of the vacuum bell might be explained via the analogy of a competition between the ribcage’s firmness and the pull of muscles, including the diaphragm. Optimal responses to therapy appear to result from lifting the funnel slowly and continuously in such a way that the temporary losses of firmness in the ribcage are kept to a minimum. It should take some time (even 2 to 4 weeks) for the chest to be lifted to the degree that the funnel comes into contact with the viewing glass. The inward-pulling muscles, such as the diaphragm, become stretched by lifting the chest wall.
As a result of the complete duration of treatment, these muscles grow accustomed to their new position and to pulling the funnel less forcefully. In many cases, this growing process takes longer than any other part of the treatment.

  How Do We Use the Vacuum Bell at Home?

There are few steps, which we will describe them detailed that you need to know in order to use properly the vacuum bell:

  • Firstly you place the device on the chest. The center of it should be on top of the deepest part of your child’s pectus excavatum.
  • Then push the device onto the chest to form a seal.
  • Use the hand pump to suck the air out of the device. If your health care provider told you to pump to a certain pressure, follow those instructions. Otherwise, you should pump until you see your child’s chest wall rise.
  • Remove the hand pump and plug the end of the tubing so your child can move around and the air does not leak out of the device.
  • Leave the device on your child’s chest for the amount of time recommended by your healthcare
  • Lift the device off of the chest when the time is up.

 

If your child is under 10 years old, you should help him or use the vacuum bell. Older kids can use the vacuum bell on their own.

 

To sum up, the use of a vacuum bell device is very simple indeed. The device is placed in the center of the patient’s chest above the sternum. It is then pushed onto the chest to pressurize the space contained underneath. The hand pump is then used to force air out of this space in order to create a partial vacuum. This process causes the sternum and chest wall to be sucked out, replacing the removed air, producing a more normal appearance to the chest. It is recommended that during the initial usage, the patient should increase the pressure to a comfortable level and leave the device on for roughly 30 minutes. After this period, the device can simply be lifted off the chest to release the pressure and remove the vacuum.

With subsequent uses, as the patient becomes more comfortable with the device, they will be able to extend the period of usage and increase the pressure within the contained space to a higher level. According to the experiences of our members, the vacuum bell should be used for a minimum of 30 minutes, twice per day, and may be used up to a maximum of several hours daily. More advice from members who have used the device can be found on the blog.

After removing the device, the sternum will gradually revert to its original position. However, with the continued usage of the device, the sternum will revert less each time, until a more normal position of the sternum is achieved. It is recommended that the vacuum bell is applied regularly on a daily basis throughout the period of treatment in order to maximize the effectiveness of the treatment, though many patients decide to work up to this frequency. A typical treatment period spans between one to three years, depending on the success of the treatment, though many users experience positive effects within a few months.

  • Does it Really Work?

The initial results from using the device are extremely dramatic, though these dissipate after usage. For permanent results to be achieved, the vacuum bell must be applied regularly over a prolonged period of time. Many individuals who have used the device for a period in excess of a year have documented significant gains and some have even obtained a completely normal appearance to the chest and cured the Pectus Excavatum condition. The vacuum bell can, therefore, be considered an effective alternative and a therapeutic option when compared to the highly invasive and painful cosmetic surgery options.

A comprehensive medical study was recently conducted in order to determine the effectiveness of vacuum bell treatment. It revealed highly positive and significant results and has cemented the vacuum bell treatment as a viable and effective option.

  How Long Do Kids Need to Wear the Vacuum Bell?

At the very beginning, the child would need to wear it for 30 minutes, twice a day. After 5 weeks, when the kid will get used to it, you may increase the amount of time that your child wears it. You are free to go up to 2 hours, twice a day. Most kids need to use the vacuum bell for a year or more. Follow the recommendations from your healthcare provider for how long and how often your child should wear the vacuum bell. This way your child can get the best results.

  Are There Any Problems With Using a Vacuum Bell?

Usually, the vacuum bell doesn’t cause problems except for a little redness or bruising where it attaches to the chest. The redness goes away after a few hours. Some people in rear cases, someone can have back pain or a burning or prickly feeling in the arms while wearing the vacuum bell. If they experience this, they should take off the vacuum bell and try a lower pressure in a few hours. Call your health care provider if this continues with the lower pressure.

As we said, there are very few complications or side effects associated with the use of vacuum bell therapy. However, some patients have experienced subcutaneous hematoma, petechial bleeding, dorsalgia and transient paresthesia of the upper extremities during the application of the device, though none of which are considered serious. In addition, there are extremely rare cases where inappropriate usage has resulted in rib fractures.

   Is the Vacuum Bell Painful?

It can take some time to get used to the vacuum bell. Some kids might feel a bit of discomfort when the device is put on, but most get used to it pretty quickly.   What If My Child Won’t Wear It?

Most kids do well with the vacuum bell. But if your child struggles, try to be understanding. Work together to come up with solutions and incentives to get your child to wear the vacuum bell. They can wear the vacuum bell under a shirt or even while they sleep. Your care team is a resource — for you and your child. They are there to answer any questions and help you and your child get the best results from the vacuum bell.

  What Types of Vacuum Bell Are There?

Today, there are several different manufacturers of vacuum bells, their products have different shapes and sizes.
In our opinion, the most optimal solutions are developed in Russia.

The bells are of high quality and very effective, the prices are very reasonable.
Both a small bell for children from 3 years old (the size of the bell is only 11 cm) and giant models, up to 25 cm in diameter, were developed
international delivery is available
It should be noted that the manufacturer also offers the manufacture of a unique bell, according to the doctor’s sketches, if this is necessary for the patient, due to the characteristics of the body structure.
At the request of visitors to our website, we created a page where 10 models are presented and an order form is created, the form must be filled

Buy Vacuum Bell For Pectus Excavatum

 

Methods and Results Obtained By The People Who Have Been Wearing Vacuum Bell:

During the first few applications of the vacuum bell, all patients are experiencing moderate pain in the sternum and feeling uncomfortable pressure within the chest. Adolescent and older patients developed a moderate subcutaneous hematoma, which usually disappears within a few hours. Some patients may experience recurrent transient paresthesia of the upper extremities during the application of vacuum bell. Also, few patients may suffer from recurrent dorsalgia. In patients younger than 10 years of age, usually, there are not same critical side-effects. In all patients, the sternum and the ribs were lifted immediately after application of the device.

When starting with the application, patients presented with a Pectus Excavatum with depth from 2cm to 5cm. In more than 60% of the patients, after 3 months of treatment, an elevation of more than 1.5 cm is documented. In almost 10% of the patients, the sternum was lifted to a normal level after 18 months.The longest follow-up after discontinuation is 5 years, and the success until today is permanent and still visible. In less than 5% of the patients with asymmetric PE, the depth of PE is decreased after 9 months, but the asymmetry is still visible. Also, some patients may not be satisfied from the result obtained by the usage of vacuum bell or may give up during the duration of the treatment. Later, they may undergo an operative treatment.

Picture:  before (left: depth of PE =2.2 cm) VB therapy, and 12 months after cessation of VB therapy (right: depth of PE =0.5 cm)

All patients are recommended to carry on undertaking sports and physiotherapy so that the accompanying improvement of body control was an important factor in the outcome. The participation of patients themselves in the ‘active’ treatment of PE clearly increases motivation to maintain therapy.

The manufacturer’s instructions and almost every doctor’s treatment protocol recommended the application of the device twice daily for 30 min each. However, the definitive duration and length of use are always determined by the individual patient and the parents, respectively. As demonstrated in the CT- scan, the force of the vacuum bell is strong enough to deform the chest within minutes. Therefore, especially in children younger than 10 years of age the application of the vacuum bell has to be performed carefully and should be supervised by an adult.

When creating the vacuum, the elevation of the sternum is obvious and persists for a distinct period of time. Therefore, the vacuum cup may also be useful in reducing the risk of injury to the heart during the MIRPE procedure, where the riskiest step of the procedure is the advancement of the introducer between the heart and sternum. Since the manufacturer of the device has not yet a license to sterilize the vacuum bell, this additional use has to be considered as a clinical trial. In addition, the vacuum bell may be useful in a way of ‘pretreatment’ to surgery.

In conclusion, the vacuum bell may allow some patients with PE to avoid surgery. Especially patients with symmetric and mild PE may benefit from this procedure. However, the time of follow-up in our series is too short to confirm this with any certainty. Additionally, the intraoperative use of the vacuum bell during the MIRPE may facilitate the introduction of the pectus bar. This must be evaluated by further studies. In any case, the method seems to be a valuable adjunct therapy in the treatment of PE.

How do you get a Vacuum Bell?

Obtaining a vacuum bell can be a difficult process since they are not commercially available. To purchase a vacuum bell it is usually necessary to contact the manufacturer directly by email. Email is  vacuum.bell@bk.ru another option to buy vacuum bell for pectus excavatum treatment  you can submit form on our website.

To order a vacuum bell simply state that you are interested in purchasing their product and tell them your height and weight so that they can determine which sized device would best suit you. They will promptly respond to your query with more information about the medical device in order to help you decide whether their product is right for you.

You should also be aware that both manufacturers require that you consult a medical doctor before buying their product. Whilst Costa will accept your own word, Klobe will only sell you his product if you are able to provide written permission from a registered medical practitioner.

Occasionally, it is possible to purchase these devices from users who have finished their vacuum bell treatment. Such examples are typically made available on eBay or community-based websites .

References:

What is Pectus Excavatum?

Pectus excavatum, also known as sunken or funnel chest is a congenital chest wall malformation in which several ribs and the sternum grow abnormally, producing a Pectus excavatum occurs in an estimated 1 in 300-500 births, with a male predominance (male-to-female ratio, 3:1). The condition is typically noticed at birth, and more than two-thirds of cases are diagnosed within the first year of life. Worsening of the chest’s appearance and the onset of symptoms are usually reported during rapid bone growth seen in puberty and early teenage years. Many patients are not brought to the attention of a pediatric surgeon until the patient and the family have noticed such changes. Despite the lack of an identifiable genetic marker, the familial occurrence of pectus deformity is reported in 35% of cases. concave or caved-in appearance of the anterior chest wall and sternum.

The Nuss Procedure: is an operative technique known as minimally invasive repair of pectus excavatum (MIRPE). It was originally described by Donald Nuss and this is why it is also called the Nuss technique or pectus bar procedure. Nuss performed the first minimally invasive operation for the correction of pectus excavatum in the 1980s, but it was not until 1997 that this innovative technique was introduced to the American Pediatric Surgical Association.

Because of the early excellent results of the Nuss procedure and because of its less radical nature, the popularity of this operation has grown dramatically and it is still growing

What Are The Exact Indications That a Person May Need a Nuss Procedure Done?

Pectus excavatum patients are considered candidates for corrective surgery based on the following criteria:

  • Severity of the deformity (as determined by measurement of the chest Haller index)
  • Resulting functional impairment
  • Psychosocial impact of the deformity on the patient.

The chest Haller index is a measurement taken from a non-contrast CT scan of the chest in which a ratio is obtained between the lateral and anterior-posterior diameter of the chest wall at the point of maximal depression of the sternum. A normal chest index is around 2.5. Patients with an index greater than 3.2 have a fairly pronounced and severe pectus excavatum and will typically benefit from operative correction. Even if asymptomatic, those patients usually benefit from the corrective surgery.

 

Of note, obtaining a chest Haller index in a young patient with pectus excavatum is not necessary. The Haller index should be obtained before corrective surgery (within months and not years) so that it can offer information helpful to the surgeon in planning the operative correction of the pectus.

Symptomatic patients with pectus excavatum typically experience occasional episodes of chest pain, shortness of breath with exertion, and decreased exercise tolerance. Such patients usually have abnormal pulmonary function test results, and echocardiography may demonstrate mitral and tricuspid valve regurgitationMitral valve prolapse is also commonly seen on the echocardiogram.

Many patients with mild-to-moderate pectus excavatum do not report any significant shortness of breath. Upon further questioning, however, one may find that the child is unable to keep up with their peers during play and physical activity. They usually report getting tired more easily.

Another common observation in children with pectus excavatum is that they are very shy and reserved about their physical appearance. Frequently, as summer comes around, they are unwilling to take their shirt off for sports, swimming, or around other children. The psychosocial stress caused by the abnormal chest can be quite severe and can result in a major adjustment disorder, depression, and even suicide ideation later in life.

The most common goal in the operative repair of pectus excavatum is to correct the chest deformity. As noted above, this is particularly important in teenagers, in whom the abnormal appearance of the chest can result in significant problems related to body image and self-esteem. Thus, the desire to improve the appearance of the chest is considered an appropriate medical indication for surgery.

The current recommendations support the use of MIRPE in patients aged 5-20 years. The ideal age for undergoing this operation has been established at 8-12 years because, in this age range, the chest wall is still very malleable, stabilization of the bar is easily achieved, thoracic epidural can be safely placed, and the child is mature enough to understand the operation and postoperative instructions, particularly incentive spirometry, which is essential for minimizing pulmonary problems after surgery.

Of note, operative correction of pectus excavatum should not be viewed as an operation limited exclusively to pediatric patients. Indeed, the open technique has been used in adult patients with excellent results. Although experience with MIRPE in adult patients has been relatively limited, there is increasing evidence to suggest that similar principles apply to adult patients and that operative correction using MIRPE can be achieved in this population.

Limiting factors for MIRPE in adults include a larger chest wall and poor malleability of the ribs, cartilage, and sternum. A surgeon experienced in the field of chest wall malformations must carefully evaluate adult patients to determine which operation would best correct the anatomical deformity.

Moreover, adult patients with pectus excavatum who undergo open-heart surgery have significant displacement and rotation of the heart to the left chest. This can make the operative approach to the heart at the time of open-heart surgery very challenging. With this in mind, elective repair of the pectus deformity prior to open-heart surgery may be indicated in selected adult cases.

In a retrospective multicenter study of 20 adult patients with recurrent pectus excavatum, Kocher et al found MIRPE to be safe and effective for repairing the recurrences after a failed Ravitch procedure. The results were good-to-excellent in the majority of adults, and there were no major complications or further recurrences

Technical Considerations For Nuss Procedure:

Best practices

Not all patients with pectus excavatum are considered candidates for corrective surgery. The decision to undergo surgery is based on clinical symptoms and the severity of the deformity. The surgeon, patient, and immediate family must reach a consensus as to the benefits of operative repair for the child with pectus excavatum. The morbidity and mortality of the surgical intervention must be taken into consideration.

Procedural planning

Patients must be selected carefully for the procedure. Preoperative assessment may include pulmonary function testing (PFT) and contrast computed tomography (CT) of the chest. CT allows determination of the preoperative Haller index (as previously described). Patients with a Haller index greater than 3.2 are considered candidates for the minimally invasive repair. PFT typically demonstrates mild changes in pulmonary volumes (restrictive pattern). Echocardiography is performed selectively in patients with clinical evidence of Marfan syndrome or with any cardiac symptoms or murmurs.

Complication prevention

Appropriate patient selection and careful attention to operative and technical details minimize the risk of complications. Moreover, recognizing that the ideal age for operative repair is between 8 and 12 years of age is important. Prepubertal patients have a more flexible rib cage, which facilitates reconstruction and remodeling of the ribs and sternum. Younger patients typically experience less postoperative pain and discomfort than teenagers and young adults do.

Outcomes:

Few studies have been done and published that are evaluating the short and long-term outcomes of patients following minimally invasive repair of pectus excavatum. The overall patient and family satisfaction have been considered very good, with excellent and good results reported in more than 90% of cases.

In 2000, a multi-institutional study that reviewed 251 MIRPE cases demonstrated a significant complication rate (overall incidence of complications was almost 20%). The most common complication necessitating reoperation was displacement of the retrosternal stainless steel support bar (reported to occur in 9.5% of all patients). Such displacement can include a 90° rotation, a 180° rotation, or a lateral migration. Teenaged patients are at higher risk for complications, particularly pectus bar displacement, probably because of the increased pressure on the bar generated by a larger chest and a more rigid chest cage.

The rate of complications was found to be relatively high when many different surgeons performed the operation. This probably reflects the learning curve associated with the introduction of MIRPE. Since the first such procedure was performed, the bar has been modified four times; current bars are strong enough to withstand the pressure of even the most severe deformity.

Factors contributing to the results reported include the softness of the bars initially used, the premature removal of the bar, and the failure to stabilize the bar adequately.  Experience has shown that stabilization of the bar is absolutely essential for success and that the use of a lateral stabilizing bar and the third point of fixation (when appropriate) can minimize the occurrence of bar displacement.

The spectrum of adverse outcomes is variable, and most complications are considered rare and unusual. The following is a list of reported complications after MIRPE (and their estimated incidence):

  • Pectus bar displacement requiring reoperation (2.5%)
  • Pneumothorax necessitating chest tube (3%)
  • Overcorrection (3%)
  • Epidural catheter complications (4%)
  • Bar allergy (1-2%)
  • Wound infection (1%)
  • Pleural effusion (1%)
  • Thoracic outlet syndrome (<0.5%)
  • Pericarditis (<0.5%)
  • Cardiac injury (<0.5%)
  • Sternal erosion (<0.5%)
  • Death (<0.2%)

With respect to cardiopulmonary outcomes after MIRPE, a study has demonstrated that objective measures of forced expiratory volume in 1 second (FEV1), total lung capacity, diffusing lung capacity, and respiratory quotient all showed significant improvement (after bar removal) in comparison with preoperative values, whereas normalized values of cardiac index at rest did not.

It should be noted that this improvement in cardiopulmonary function is not necessarily seen during the time that the support bar is still in place. For that reason, functional outcomes should not be evaluated until the patient has completed treatment with bar removal. Of note, the dreaded complication of chest wall constriction after Ravitch repair of pectus excavatum has never been reported with the Nuss procedure.

Attempts have been made to determine which technique (ie, MIRPE or open surgery) provides the better outcome in patients with pectus excavatum. Although many surgeons with expertise in the management of children with chest wall deformities have shown some bias toward the use of the Nuss technique, this bias is not strongly supported by prospective randomized published data.

A systematic review by Johnson et al compared outcome measures for Nuss and Ravitch procedures (as well as other, less common approaches) in both pediatric and adult patients. The results indicated slightly better outcomes with the Nuss procedure than with any other approach in children; in adults, the results did not lead to a preference for the Nuss procedure over the Ravitch procedure or vice versa, though both were preferred over the less common approaches.

Since the introduction of thoracoscopy and lateral stabilizers, as well as the third point of fixation technique, bar displacement has become quite unlikely, with an estimated incidence of less than 2.5%.

Another significant advantage of MIRPE over the open surgical procedure is that the dreaded complication of “thoracic constriction” (Jeune syndrome) does not seem to occur with this new technique. Chest wall constriction has been described in a few patients following extensive open pectus excavatum operations. Apparently, the bone growth center can be affected, which results in restriction of chest wall growth with marked limitation of ventilatory function. Such patients are very symptomatic and cannot compete in running games. The forced vital capacity and FEV1 are typically decreased by more than 50% of predicted reference range levels.

With MIRPE, because no resection or incision is made on ribs or cartilages, such a complication does not appear to be a problem. Once the cartilage and bony structures are remodeled, normal or improved pulmonary function is established and the flexibility and malleability of the chest remain unaffected.

Critics of MIRPE claim that it is too invasive, poses substantial risks and is not pain-free. Proponents argue that MIRPE, compared with open surgery (modified Ravitch operation), eliminates the need for an anterior chest wall incision with the creation of pectoralis muscle flaps, resection of several ribs and cartilages, and sternal osteotomies. MIRPE allows a much shorter operating time, causes minimal blood loss, and results in minimal surgical chest wall scarring. Moreover, the stability and strength of the chest wall are not compromised, as is sometimes the case with open repair.

Data published in 2011 by the multicenter study group evaluating the pulmonary functional outcome of pediatric patients with pectus excavatum treated with MIRPE clearly demonstrated that the increasing severity of pectus excavatum is associated with reduced pulmonary function and that the Nuss operation can effectively reverse that process.

Final data analysis generated by the multicenter study and published in 2013 clearly demonstrated that there is a significant improvement in lung function at rest and in VO2 max and O2 pulse oximetry after surgical correction of pectus excavatum with a CT index greater than 3.2. The study concluded that operative correction significantly reduces the CT index and markedly improves the shape of the entire chest and cardiopulmonary function.

Patient Education and Consent:

 

Patient instructions

All patients should avoid all oral intake (nil per os [NPO]) for 12 hours before general anesthesia. Gentle bowel preparation with magnesium citrate might be of benefit in older patients, in that postoperative constipation is quite common after discharge from the hospital, primarily because the patients have taken large amounts of narcotics that will predispose them to constipation.

Elements of informed consent

The informed consent should include a discussion of the treatment options, including nonoperative management, minimally invasive repair, and open surgery. Short and long-term outcomes should be discussed with the patient and caregivers/parents. The risks, morbidity, and mortality must be discussed.

The most common complication (bar displacement) and the possible need for preoperative surgery must be discussed. Although rare, the possibility of death must be discussed. Patients with an asymmetric pectus excavatum must be made aware that the asymmetry of the chest may continue despite successful repair of the caved-in sternum.

  Monitoring & Follow-up:

Intraoperative monitoring typically includes standard anesthetic monitoring and pulse oximetry. Placing an arterial line and/or central line for hemodynamic monitoring is not necessary. Due to the presence of the thoracic epidural and high use of postoperative narcotics, having patients monitored in a critical care unit (such as a pediatric intensive care unit [PICU] or step-down unit) after the procedure might be necessary because of the risk of postoperative respiratory depression.

 

The patient is discharged home once the pain is adequately controlled with oral medications. The average length of stay is 4-7 days. Good posture with a straight back is very important, even after discharge.

 

Once at home, the patient may sleep in any position that is comfortable. Again, bending at the hip and slouching are discouraged, particularly in the first month. Regular activity is permitted as pain reduces and mobility increases. Heavy lifting is not permitted for 1 month after surgery.

 

A physical fitness program should be started 30 days after corrective surgery in order to promote healing and remodeling of the chest wall. Contact sports should be avoided for at least 6 months, particularly in older children and teenagers; a direct blow to the chest may predispose the patient to bar displacement.

 

References:

Causes of Pectus Excavatum and Exercises

Pectus Excavatum Causes

Pectus Excavatum causes are still unknown because researchers are unsure of the cause. They do assume that there is a genetic component involved in this deformity. Pectus Excavatum occurs in 1 to 1000 births with a 3:1 male to female ratio.

Pectus excavatum is a relatively common symptom of Noonan syndromeMarfan syndrome and Loeys-Dietz syndrome. It is also found in other connective tissue disorders such as Ehlers–Danlos Syndrome.

Pectus Excavatum Causes

 

What can be the treatments for this deformity?

Pectus excavatum treatment is not required in mild cases. The other deformity of this type is called funnel chest. Treatment of severe cases can involve either invasive or non-invasive techniques or a combination of both. Some remedies of this deformity are:

  • Exercise

Physical exercise is important in conservative pectus excavatum treatment though is not seen as a means to resolve the condition on its own. It is used in order to halt or slow the progression of mild or moderate excavatum conditions and to prevent relapse after treatment.

  • Magnetic mini-mover procedure

In this procedure, using two magnets to realign the sternum with the rest of the chest and ribcage uses a technique. One magnet is inserted 1 cm into the patient’s body on the lower end of the sternum and the other is placed externally onto a custom fitted chest brace and over a number of years, these two magnets slowly pulls the sternum outwards.

  • Plastic surgery for Pectus Excavatum Surgery

Plastic surgery involves two stages, implants and lipo filling.

  • Implants: This procedure is used as a benchmark procedure as it is simple and reliable method offering aesthetically pleasing results although, it doesn’t correct existing cardiac and respiratory problems which can sometimes are triggered by this condition. For females, the potential resulting breast asymmetry can be partially or completely corrected by this procedure. The surgery is performed under general anesthesia and takes about an hour and is 90% safe without any after effects.

  • Lip filling: This technique consists of sucking fat from the patient, usually from the abdomen or the outer thighs, then re-injecting the fat cells beneath the skin into whichever hollow needed to be filled.

Is it fatal or just esthetic?
As per doctor’s view, it is not that much fatal as there is no such report of death.

Anyway, have you still questions or are you curious? You can ask your questions to people all arround the world. Go to Question and Answer Page

Pectus Carinatum Brace Treatment

Brace Treatment

The Brace treatment is a non-surgical way to cure this deformity. This treatment involves the fitting of the brace, which a person needs to wear for long hours every day. This generally takes around six months to get the desired result. However, the satisfaction may vary from person to person since same treatment might not be applicable for all. Compressive bracing results in a significant improvement followed by regular appointments for checkup.

Pectus carinatum brace surgery is quieting efficient and non-risky. The ill effects of this can only stretch to irritation only. If there is a moderate severity then this will be cured quickly within a few months. The self-adjustable, low profile bracing system is used in two phases. The first involves 24 h/d bracing until correction is achieved. The second phase is the maintenance phase during which the brace is worn only at night until axial growth is complete. If this procedure fails then there can be a surgical intervention needed to cure this.

How to Treat Pectus Carinatum?

Incision is made on the chest wall to cure this deformity by using the endoscopic approach. In 2008, Fonkalsrud reported a surgical strategy, which was more efficient than any other method. He said that the trend towards less extensive open techniques has resulted in “low morbidity, mild pain, short hospital stay and very good physiologic and cosmetic results.” The pectus carinatum deformity can at times be associated with congenital heart disease. Some with decreased endurance as well as asthma can benefit from pulmonary evaluation. While for some, this deformity can diminish their self-esteem, which is why they opt for surgeries.

Other Treatment Methods for Pectus Carinatum

The exercises, which target the muscles surrounding the chest cavity to grow so that the appearance of the outward chest cavity decreases. It has not yet been proved to be applicable and a permanent solution yet. Sometimes, this deformity is associated with heart diseases. It is advisable not to do any hard exercises after the surgery so that there is no pain.

We have also shared a video about Brace Treatment for Pectus Carinatum

vacuum bell for pectus excavatum

What is Vacuum Bell? A treatment method for Pectus Excavatum!

The Therapy Of Vacuum Bell Method

Vacuum bell treatment for pectusIn addition to surgical repair of Pectus excavatum, the vacuum bell was introduced more than 10 years ago. It is a conservative treatment to correct the pectus excavatum. The preliminary results of Vacuum Bell are encouraging.

With the vacuum bell treatment that is based on 13-year of experience during the Nuss procedure the intraoperative use some technical innovations.

 

Nuss Procedure or Vacuum Bell?

You know that there is a treatment called as Nuss Procedure for Pectus Excavatum. But also there is another which we mention as Vacuum Bell Method. This method is used from the patients who don’t want to be operated. And it si usefull, painless also handy!

Vacuum Bell Methods

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vacuum bellTo create a vacuum at the anterior wall of the chest a Vacuum Bell with a patient-activated hand pump is used. There are three different types of sizes of vacuum bell are available. There exists a model that is fitted for young women. According to the patient’s age and ventral surface the appropriate size of vacuum bell is selected. For a minimum of 30 minutes twice a day it should be used at home. It can be used for a maximum to several hours daily. During follow-up visits with an integrated gauge the intensity of the applied negative pressure can be evaluated. There is a prototype of electric models that are used to enable the measurement of the correlation between the elevation of the anterior wall of the chest and the applied negative pressure.

Vacuum Bell Results

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vacuum bell resultsApproximately, 450 patients between the age of 21 to 61 years have been started the vacuum bell therapy since 2003. The clinical course and the success of vacuum bell therapy can be influenced by the age and gender-specific differences, symmetry or asymmetry, depth of PE, and the concomitant malformations such as kyphosis, and scoliosis. There are three different groups of patients are seen. In almost every patient during the Nuss procedure an immediate elevation of the sternum was thoracoscopically confirmed. Since last 13 years, almost 434 patients including female and male started treatment with vacuum bell therapy. For which types of patients is it effective? The majority of the patients are children and adolescents

Are you curious what people says?

We have created a forum for people who using Vacuum Bell. And they may have told about Vacuum Bell treatment. Let’s chech our forum! Go to Forum >>

Technical Details of Vacuum Bell

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There are three different sizes of vacuum bells are available, they are 16, 19 and 26 in diameter. According to the individual ventral surface and patient’s age the size of the vacuum bell is chosen. In a supplementary surface with reinforced silicon wall the medium-sized model is available. With a small deep Pectus excavatum the medium sized model is suited for the adult patients. A special fitted model is available for the adult and adolescents female patients

For a minimum of 30 minutes twice a day during 4-6 weeks of vacuum bell should be used and it is done according to the instructions and experiences.

Indications, Contradictions, and Side Effects

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using vacuum bellGenerally, the vacuum bell therapy is feasible at any age. The important factors are the patient’s age and the ventral surface for local application. There are some contraindications that include vasculopathies, musculoskeletal disorders, cardiac disorders, and coagulopathies. Before beginning the therapy a standardized evaluation of the protocol is routinely performed to exclude these disorders

There are some complications, which include; during the vacuum bell are petechial bleeding, subcutaneous hematoma, and dordalgia and transient parasthesia of the upper extremities.

Why should buy and use it?

For better results vacuum bell is used. If you still have questions on your mind, you can write a comment us or write on our blog to other peoples who have used Vacuum Bell.

There Are Ten Size Of Vacuum Bell Available

diferent sizes of vacuum bell

 

Let’s Learn “What is Vacuum Bell” from our Youtube Channel!

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Do you want to learn more about Pectus Excavatum?

If you want to learn more, click here -> Pectus Excavatum – Signs, Symptoms and Causes

Nuss procedure is an operation to cure pectus excavatum. And it is a minimally invasive technique that uses a retrosternal bar and this is the most recent procedure for pectus.

What Is Nuss Procedure: Newest Procedure For Pectus

Dr. Donald Nuss invented the Nuss procedure in 1987 and it is a minimally invasive procedure and it is used for treating pectus excavatum. Nearly two hours is needed for this operation. An introducer is pressed along with posterior to the sternum and ribs and anterior to the heart and lungs and they are placed through two small incisions that are made in the sides of the chest and then a stainless steel bar which is concaved is pushed underneath the sternum through the same incisions in the side of the chest. Then a thoracoscope or a small camera is used as a guide of the bar and to insert it a smaller incision is made.

Patients who are taller and older or who need extensive correction may get two or more bars. And for placing these bars two or more incisions may be made. Then the bar is tossed and the sternum pops out. With the bar on one side of the torso a plate made of metal, which is called stabilizer, may also be inserted to keep the bar in place. In addition to the stabilizer PDS sutures can as well be used. Muscle tissue that grows through recuperation time secures the bar.

At the beginning this procedure was suggested only for patients who are young but now it is also applied on patients who are thirty and forty year old and that too with brilliant consequences. Despite the fact that the procedure is classified as “minimally invasive”, post-operative pain control may be pretty exigent and consequently requires multi-modal pain management including epidural anesthetics. Nurses attending these patients after operation normally agree that for children this operation is one of the more hard recoveries of any operations.

An Example for Before and After Pectus Excavatum

 

THE NEWEST PROCEDURE FOR PECTUS

It is admit able that when it comes to the question about the latest technique for pectus nuss procedure is the solution or answer to that question. Patients with pectus excavatum are considered as the candidates for this surgery but it is not that all patients who have pectus excavatum are considered for this surgery. Patients who are selected for this surgery are based on some symptoms that are clinical and that should be done with care.

Assessments that are preoperative could contain pulmonary function testing or PFT and noncontract computed tomography or CT of the chest. Determination of the preoperative Haller index are allowed by CT. Patients who have haller index that is greater than 3.2 are considered for minimally invasive correction. Mild changes in pulmonary volumes are demonstrated by PFT. Patients who have clinical evidence of Marfan syndrome get echocardiography.

When many different surgeons performed nuss procedure the rate of complications were high but since it was first performed the bar has been amended four times. And the bars that are used nowadays are sturdy enough to withstand the strain of even the harshest malformation.

 Nuss Procedure is newest treatment for Pectus Excavatum.

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