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Free sternum turnover flap for correction of pectus excavatum deformity.

Pectus excavatum, also known as funnel chest, is by far the most common congenital chest deformity.1–4 It is characterized by a depression of the anterior thoracic cage, which is attributed to the overgrowth of the costal cartilages.5 Familial factors are thought to influence the occurrence of this deformity. It is present at birth and is usually progressive; the female-to-male ratio is considered to be 1:3 to 1:4.1 Most patients express concern about their appearance without having functional problems. However, psychological and social withdrawal and physiologic disturbances may occur because of cosmetic concerns and, in severe cases, heart and lung compression.6–8 Conventional treatments include the following: the sternochondroplasty, introduced by Ravitch9; modifications of the sternochondroplasty procedure with or without sternal support by metal struts or Marlex mesh7,10–12; insertion of silicone implants2,13; the minimally invasive Nuss procedure, which is increasingly popular in the pediatric surgical literature14,15; and the simple sternal turnover technique, in which the sternum and attached cartilages are used as a nonvascularized composite graft.3 However, the drawbacks of these procedures include possible bone resorption leading to recurrence, fibrosis of cartilage, infection or dislocation of the implant, and unimproved physical condition.6,16–18 On the basis of our anatomical studies and clinical experience with the internal mammary vessels,19–25 we introduced our approach to the funnel chest correction in which revascularization of the turned-over sternum is accomplished by microvascular anastomosis of the internal mammary vessels. This report presents our surgical procedure and experiences with four patients treated with a free sternum turnover flap for correction of pectus excavatum.