Open techniques represent a valid repair option for severe asymmetric
pectus excavatum in adults. The use of
metal supports is recommended to reduce the risk of recurrence. A wide variety of
metal supports have been proposed, with pre-, trans- or retrosternal fixation. A novel open technique using
titanium bars fixed to the ribs with clips has been recently introduced (STRATOS™ system) for chest wall reconstruction,
rib fracture fixation and chest wall malformation repair. We employed this technique in two adult patients with severe asymmetric
pectus excavatum: after sternal mobilization, one bar is passed below the body of the sternum and secured with clips bilaterally to two ribs. In the first case, the results remained excellent 5 years after surgery. In the second case, the initial results were satisfying but the bar ruptured after 30 months: removal of the bars and clips was performed and a subsequent recurrence of the
deformity occurred. The experiences reported in literature are still too limited to draw firm conclusions about the use of the STRATOS™ system in
pectus excavatum repair, but it seems that the use of two bars may reduce the risk of
rupture. At present, we are the only ones who reported long-term results.