These congenital deformities, funnel or keel chest deformities, as well as Poland syndromes, affect a small group of patients who suffer from aesthetic rather than functional impairment. The wide variety of diagnoses and recommended therapies, mostly surgical procedures, can be very confusing for patients, their parents, physicians and surgeons. In recent years several techniques have been refined and developed to deal with these complex problems, and surgeons with different specialties have been operating on these deformities, mostly as lonely experts in their respective fields.


This book should not be seen as an operation atlas but more as a compact survey of a small group of medical conditions and the need for flexible options for an individual therapeutic approach, based on the combined experience of different international specialists. Thus the book is designed for obstetricians, pediatricians, physicians and surgical specialists alike.


Preverb


1. Introduction Historical treatment


2. Deformities of the anterior thoracic wall

2.1 Anatomy and function of the thoracic cage

2.2. Etiology, Genetics

2.3. Classification/Definition (Description of typical deformities )

2.3.1. Funnel chest

Subgroups

2.3.2. Keel Chest

Subgroups

2.3.3. Pectus arcuatum

2.3.4. Mixed Deformities

2.3.5. Cleft Sternum

2.3.6. Poland Syndrome, Amazone Syndrome

2.3.7. Other congenital anomalies of the thoracic wall




3. Diagnostics

3.1. Photography

3.2. Measurement circle

3.3. X-ray

3.4. CT-scan

3.5. Volume rendering three-dimensional-CT reconstruction

3.6. Ergometry

3.7. Psychological investigation


4. Aspects of indication setting for selection of individual therapy


5. Therapy

5.1. Basic surgical techniques, principles, methods of skin incision

5.2. Patient positioning

5.3. Special surgical techniques


5.3.1. Surgery of the funnel chest

5.3.1.1. MIRPE, the Nuss technique

in children

in adults

5.3.1.2. Custom-made silicone implant

5.3.1.3. The Ravitch procedure

5.3.1.4. The Erlangen methode

5.3.1.5. The Leonard procedure

5.3.1.6. Vacuum bell after Klobe (non surgical)

5.3.1.7. Autologuous tissue implantation

5.3.1.7.1. Cartilage chips

5.3.1.7.2. Lipofilling

5.3.1.7.3. Local flaps

5.3.1.7.4. Mikrovascular flaps

5.3.1.7.5. Mikrovascular sternum turn-over


5.3.1.8. Special technical aspects, thoracoscopy

5.3.1.9. Special anaesthetical aspects,

double lumen intubation, pain control



5.3.1.10. Combined surgey of funnel chest with associated anomalies or diseases


5.3.1.11. Pectus bar removal technique


5.3.2. Surgery of the keel chest

5.3.2.1. The Ravitch technique

5.3.2.2. Modification with bioabsorbable implants and muscle splitting technique, the Innsbruck concept

5.3.2.3. Special after-treatment, keel chest device


5.3.3. Surgery of Pectus arcuatum

5.3.4. Surgery of mixed deformities

5.3.5. Surgery of Poland syndrome, Amazone syndrome

free flaps for treatment of Poland Syndrome


5.3.6. Surgery of other congenital anomalies of the anterior thoracic wall


6. Complications, special problems


7. Follow-up, long term follow-up


8. Special instruments


9. Actual technical improvements, future aspects, 3 D Scanning and computerized remodelling


10. List of authors