The Use of Soft Silicone Solid Implant Molded Intraoperatively for Pectus Excavatum Surgical Repair

Purpose: The solid customized and prefabricated silicone implants have been used by many surgeons for a long time in chest wall deformities such as Pectus Excavatum, without any impairment of cardiopulmonary function. The implants can be either customized using a moulage technique or prefabricated which can be modified on the operating table to repair the contour deformity. The silicone consistence has a role in the final aesthetic result. A hard implant may become visible by rising or moving the arms, may be easily recognized when touched and also needs large incisions. We present the experience from 1998 to 2017 with a new type of super-soft solid silicone and the aid of videoscopy for dissection in the treatment of Pectus Excavatum.

 Method/Technique: The defect in the contour of chest wall is measured in the pre-operative period. A super-soft silicone rectangular block is customized. The base and the height correspond to the maximum measures of the wall defect.  The access incision is horizontal, 4 cm large and 2cm away from the implant positioning. The plane of dissection is anterior to the muscle, periosteum and pericondrium. The endoscope is used to improve the visibility with a 4mm or 5 mm, 30º angle optic system. When the surgical pocket is ready, the space is measured, and the block is sculptured. The posterior base of the implant must fit the contour of the ribs and the sternum to fix the implant and to prevent its movement. The same procedure is done in the anterior border of the block. The implant can be easily folded to be introduced.  The implant must be fixed to the sternum by non-absorbable stitches. A tubular suction drain is maintained 5 to 7 days.

 Results: From 1998 to 2017, 47 patients with Pectus Excavatum were treated, 38 of them had with only a medial depression and one had also with rib alterations in the right side of the thorax. The only complication was seroma in 17 patients, drained with needles from 1 to 3 times. The results were considered satisfactory. The patients are physically active, and the implants show no long-term sequelae such as infection, displacement, or rupture. There was no subcutaneous “show” even in movements.   

 

Conclusions:  The major advantages in this technique are the minimally invasive operation, the short hospital stay, the good aesthetic results and the patient high satisfaction. The use of endoscopy resulted in shorter incisions and more gentle technique. The super-soft solid silicone implant provides a more aesthetic result.