Pectus excavatum is a congenital development of the rib cage causing the sternum to be sunken in.
The defect is often present at birth but becomes much more pronounced with the adolescent growth spurt.
Pectus Excavatum is treatable. It may be symmetrical or asymmetric when the defect is to one side of the chest The pectus deformity pushes the heart into the left chest. When severe it also compresses the lungs causing shortness of breath with exercise.
The patients present with shortness of breath, chest pain (with or without exercise), symptoms of asthma and often have an associated scoliosis. They also often have psychological difficulties related to a poor self-image. They all have a cosmetic deformity but the symptoms are very real and need to be addressed.
Pectus carinatum tin is the protrusion of the sternum, the opposite of Pectus excavatum. They are two ways of correcting this defect, the one surgical and the other an external brace.
Surgical repair of a pectus carinatum involves inserting a metal bar in front of the sternum compressing it into the correct shape. [Abrahams procedure] the principle of this operation is similar to that of the Nuss procedure, constant compression.
The alternative way of correcting the pectus carinatum is the use of an external chest brace. Many braces are available but the preferred brace now universally used is the dynamic compression brace. The advantages of this brace are that the pressure used to correct the problem can slowly be increased as the carinatum corrects. Too much pressure on the brace damages the skin as well as causing significant pain. Gradually increasing the pressure avoids these complications. The brace is also adjustable as the patient grows. This is especially relevant in the adolescent group. The dynamic compression brace is measured individually and custom-made for each patient.
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The Pectus Clinic
The Pectus Clinic is the group that brought the Nuss procedure to South Africa and subsequently to Africa. The director (Ivan Schewitz) is an executive member of the Chest Wall international Group.(CWIG) and has an extensive experience with both the Ravitch procedure as well as the minimally invasive Nuss procedure. This is the surgical treatment of chose for pectus excavatum, while the reverse Nuss is the preferred surgery for pectus caranitum.
Prof Donald Nuss is a Cape Town graduate who introduced his repair in 1997. Since than the Nuss procedure has revolutionised the surgical repair of pectus excavatum. Subsequently Prof Abraham from Argentina introduced the reverse Nuss for pectus carinatum, which bears his name.