October 12, 2009

Nuss Procedure for Pectus Excavatum

PA and lateral chest radiographs show a retrosternal Nuss bar in a patient following Nuss procedure. Note the retrosternal location (arrow) and the intercostal attachments (arrowheads) of the bar.

Facts: Nuss Procedure
  • New approach to repair pectus excavatum
  • Simple technique with better cosmetic results; aiming to elevate the deepest part of the depression
  • Done by placing a retrosternal metallic bar through small incisions in the intercostal space. The bar penetrates the pleural cavity at the hinge point at either side.
  • Several types of bars available to choose depending on the morphology of pectus excavatum
  • It is important for surgeon to elevate the deepest part of the depression, which is not necessarily the center of the sternum!
  • Most common = pneumothorax
  • Followed by: bar displacement, seroma, pleural effusion, pericardial effusion
  • Bar displacement can be: 1) flipping (most common), 2) lateral sliding, 3) backward shift
Park et al. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg 2004;77:289-295.

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