New Article published in EJOPS: evolution of surgical strategies for chest wall deformities

Source article: The evolution of surgical strategies for chest wall deformities with digital planning and custom implants: a narrative review by Van Steen R, Van Dieren L, Van den Bossche R, Fawcett V, Deblier R, Vermeersch N, Tondu T, Lellouch AG, Berkane Y, Thiessen P.

This article provides a clear summary of a 2026 scientific review exploring the evolution of surgical strategies for pectus excavatum. It compares traditional thoracic remodeling techniques such as the Nuss and Ravitch procedures with newer, less invasive approaches using 3D custom-made implants.

 

Pectus excavatum is a common chest wall deformity characterized by a sunken sternum. In most cases, cardiopulmonary impairment is minimal, while the main burden is aesthetic and psychosocial.

Recent advances in 3D imaging, CAD (computer-aided design), and 3D custom-made implants have transformed treatment strategies. The article emphasizes that there is no single best technique: management must be individualized.

Comparison of Surgical Techniques

TechniqueObjectiveSurgical approachInvasivenessTypical outcomes / considerations
Nuss procedureAnterior displacement of the sternumInsertion of a curved metal bar within the thoracic cavityMinimally invasive but intrathoracicAssociated with postoperative pain, risk of complications (e.g. bar displacement, cardiac injury), and variable functional improvement
Ravitch procedureStructural correction of the chest wallOpen surgery with cartilage resection and sternal repositioningHighly invasiveEffective for structural deformities but associated with significant surgical morbidity and longer recovery
Implant-based reconstruction (3D custom-made implants)Morphological correction by filling the chest wall defectPatient-specific implant placement, typically extrathoracicLess invasive, no intrathoracic manipulationShorter operative time and hospital stay, lower morbidity, suitable for patients with limited functional impairment

Understanding of the Approaches

Nuss

Goal: Push the sternum outward

Approach: Internal metal bar

Key point: Acts on bone structure

Ravitch

Goal: Reshape cartilage and sternum

Approach: Open surgery

Key point: Structural correction

3D Custom-Made Implants

Goal: Fill the chest depression

Approach: External implant

Key point: Morphological correction

Key Takeaways

  • Pectus excavatum is often not functionally severe.
  • Treatment is frequently driven by aesthetic and psychological factors.
  • Nuss and Ravitch techniques target the bone structure but are more invasive.
  • 3D custom-made implants offer a less invasive and personalized alternative.
  • The best treatment depends on patient-specific factors.