Pectus excavatum. A clinical study with long-term postoperative follow-up

Between 1972 and 1987, 192 patients have been operated upon for pectusexcavatum of which 152 patients were included in the study (79%). Mean ageat operation was 15.3 +/- 5.5 years; 117 were male. Mean follow-up was 8.1+/- 3.6 years. The deformity was noted before the age of 5 in 90%. Type Isymmetrical and localized deformity was seen in 33.2%, type II symmetricalbut diffuse depression in 23.7% and type III localized or diffuseasymmetrical deformity in 43.1%. It was considered severe in 68.9%, fair in16.9% and mild in 14.2%. There were significantly more asymmetrical defectsin the older age groups. The operation consisted of subperichondralchondrectomy, transverse sternotomy and division of the intercostal bundlesat the outer limit of the chondrectomy and suturing the edge of this broadsheet of muscle and perichondrium to the anterior surface of the chest wallmore laterally and under tension, elevating and stabilizing the sternum.Results were satisfactory in 83.6% (excellent 44.1%, good 39.5%). Resultswere not significantly influenced by age, sex, severity, type, symmetry,the extent of cartilage resection or follow-up. Results were inverselyinfluenced by the occurrence of wound problems. The optimal age foroperation is considered to be between 5 and 10 years. Both physical as wellas psychological cosmetic factors may serve as an indication foroperation.