Pectus excavatum and carinatum

Our pediatric chest wall specialists take the time to talk to children and their families to ensure they understand their treatment options. We generally do not operate on children with chest wall conditions who are 6 years old or younger. However, we evaluate children at every age and develop individualized treatment plans for them.

We use a variety of surgical and non-surgical methods to treat chest wall conditions, including:

• Bracing
• Modified Ravitch technique (surgical removal of the cartilage causing the defect)
• Nuss procedure (inserting bars behind the sternum to push it into a normal position)
• Vacuum bell (using suction, or a vacuum, to pull the chest and breastbone into a normal position)

Bracing

An external brace can be used to treat pectus carinatum without surgery. The brace gently pushes the chest into normal position over time. In most cases, pectus carinatum can be corrected entirely with bracing in 3-6 months.

With this treatment, a unique brace is made for each patient. An orthotist makes recommendations on how often the brace must be worn. With follow-up visits, the brace may be adjusted to contour to the child's chest as they grow and their condition improves.

Modified Ravitch technique

The modified Ravitch procedure is a surgical technique used to treat pectus carinatum, pectus excavatum and Poland syndrome, usually in young adults. It involves making an incision across the chest and removing the cartilage causing the defect. The sternum is then placed in the standard position. In procedures used to treat pectus excavatum, a small bar is inserted under the sternum to hold it in place.

Surgery for pectus carinatum creates scar tissue around the ribs. This can affect how the ribs grow. Therefore, surgery is usually delayed until the child completes their growth phase.

Nuss procedure

Our pediatric surgeons are experts at performing the Nuss procedure, which is the most common surgical treatment for pectus excavatum. This minimally invasive technique involves inserting a metal support bar underneath the sternum to reverse the depression in the chest. The bar inserted during the procedure is typically left in place for two to three years.

We strive to make patients as comfortable as possible following surgery. That's why, after we perform the Nuss procedure, we use nerve cryoablation to "freeze" the nerves and manage pain.

Nuss procedure for adult chest wall disorders

For optimal results, the Nuss procedure is often performed on patients during adolescence. However, it can be performed on adults. In 2017, the Director of Pediatric and Fetal Surgery at Overland Park Regional Medical Center, Corey Iqbal, MD, opened the first program in the Kansas City region that performed the Nuss procedure on adults. Before that, this life-changing treatment was only available to patients who traveled out of state to one of the three hospitals that offered it.

Vacuum bell

The vacuum bell is a non-surgical treatment for mild to moderate pectus excavatum. A vacuum bell is carefully fitted to sit comfortably on the patient’s chest. A bulb attached to the device generates negative pressure to create a vacuum, which raises the sternum over time by slowly pulling up the depressed area of cartilage.

It may take several months of use to reach the maximum correction and require up to two years of regular use to ensure sustained correction. The vacuum bell is an innovation that provides an effective treatment for patients without the time loss of surgery. Children can use the bell at a time of their choosing. The bell is worn several hours each day for six to 12 months.

In addition to the chest wall disorder treatment services available at Overland Park Regional Medical Center, we offer pediatric care at Lee's Summit Medical Center. This hospital is currently expanding its pediatric subspecialty services. HCA Midwest Health hospitals work together to coordinate care and streamline the healthcare process as much as possible for our patients.