The author presents three decades of experience in the management of anterior chest wall
deformities. During this period more than 800 operations were performed on patients with
pectus excavatum and carinatum. In this series, there was no death and serious complications were rare. The author believes that the principles on which surgical treatment of
pectus excavatum should be based are as follows: (1) bilateral removal of the "culprit" costal cartilages, (2) adequate mobilization of the sternum and correction of the sternal positional
deformity by transverse
osteotomy, (3) stabilizing the corrected position of the sternum with a substernal "hammock" support. Using this technique the author developed new surgical techniques for the correction of different varieties of chest wall
deformities:
Pectus excavatum, asymmetric
pectus excavatum,
pectus carinatum with xiphoid angulation, horizontal
pectus excavatum, asymmetric
pectus carinatum, chondrosternal prominence with chondrogladiolar depression, and recurrent
pectus excavatum. The present method applied for correction of
pectus excavatum utilizes the above principles and a substernal
Marlex mesh support with bilateral muscle coverage. For carinatum repair, the author routinely uses positional correction of the sternum and sternal shortening. Patients who have significant pectus
deformities should undergo surgical repair, preferably between one and eight years of age.