Asymptomatic Ravitch Redo with 3D implant clinical case by Pr Karen Redmond

Clinical Case: Asymptomatic Ravitch Redo

Diagnosis and surgery of an asymptomatic Pectus Excavatum Ravitch Redo by Pr Redmond

Case presentation

Implant surgery

Conclusions

Bibliography

Case presentation

Ravitch failure for Pectus Excavatum correction with visible apex beat on real life and on 3D design

 

A 38-year-old male presented with a significant pectus deformity with visible apex beat, with no impact on day-to-day activities. Relevant background history included a previous Ravitch Procedure. A computed tomography (CT) thorax demonstrated a Haller Index of 3.5:1. It was used to create a custom-made 3D silicone implant.

Surgery

Pr Redmond drawing the prototype marks on the patient for Pectus Excavatum redo surgery with 3D implants

The patient is positioned supine, chest is shaved and IV antibiotics are given intraoperatively. The implant technique is straightforward, there are marks on the implant indicating the proximal and distal marks measurements from the suprasternal notch on the implant and where the midline is. Drawing the outline of the implant with the indicates how much tissue needs to be mobilised to seat the implant.

Incision of the chest skin during Pectus surgery

The previous scar was used (instead of the usual midline scar) for improved cosmesis. Ligasure and argon are used as haemostatic devices to keep the wounds dry and limit seroma formation.

Due to the patient's previous surgery there was a large pocket already formed anterior to the sternum. We notice a fracture and defect in the chest wall from Ravitch procedure, the lung is visible in the photo on the left. A Four-layer polyproline mesh was sutured to cover the chest wall defect providing support for the chest wall and allowing for stabilization of the implant to this mesh.

A four centimeter cut was made on the lower pole of the implant to be inserted, so it can straddle the intra-muscular septum created by the superior aspects of the recti muscle insertions. The implant will be invisible under the fascia and epigastric skin.

Insertion of the 3D implant in the subcutaneous space during Pectus surgery

Operation follow-up

A negative pressure wound therapy device is worn for 2 days post-operation to limit the formation of a seroma. This seroma is removed using aseptic technique the day after surgery, and in post operative clinic if required. The patient wore a compressive vest for six weeks post-operation. Contact sports are contra-indicated for 3 months.

Wound therapy after Pectus surgery and seroma puncture

Outcome

The patient achieved his desired cosmetic outcome.

Result of pectus excavatum secondary surgery with 3D implants after Ravitch procedure failure

Author and bibliography

Author

Professor Karen Redmond is a thoracic surgeon specialized in lung cancer as well as diseases related to airways and chest deformities.

She graduated from Dublin College in 1997 with honors, receiving the gold medal in surgery. Then she developed her skills in ""minimally invasive"" surgical techniques for lung cancer as well as in thoracic surgery at Toronto General Hospital (Canada).

She is one of the first surgeons to be trained in robotic surgical techniques and has published comparative meta-analyzes on robotic lobectomy and thymectomy.

Very focused on medical innovation, she does not hesitate to discover and experiment with new surgical techniques to provide the best response to the pathologies of her patients and does not hesitate to treat complex cases of Poland Syndrome and Pectus Excavatum.

Bibliography