Kinesitherapy application features in patients after pectus excavatum repair

  • Iakiv Fishchenko SI “The Institute of Traumatology and Orthopedics” of NAMS of Ukraine, Kyiv, Ukraine
  • Liudmyla Kravchuk SI “The Institute of Traumatology and Orthopedics” of NAMS of Ukraine, Kyiv, Ukraine
Keywords: pectus excavatum, Nuss procedure, rehabilitation

Abstract

Surgical treatment of “pectus excavatum” by Nuss technique is a safe procedure that is successfully used in young people. However, after surgery, these patients face complications that limit their ability to engage in physical labor or sports.

Aim. Develop a rehabilitation program for patients who underwent surgical correction of pectus excavatum using Nuss technique.

Material  and  methods. 85 patients with pectus excavatum deformity were examined and underwent minimally invasive correction according to Nuss technique.

Results. In 82 (96,47 %) patients we managed to achieve the perfect cosmetic result. In 78 (91,76 %) patients we used one fixator, in 5 (5,88 %) – 2 fixators, and in 2 (2,35 %) patients – 3 fixators. Among the complications, 17 (20 %) patients had pneumothorax, 3 (3,53 %) – hemothorax followed by pleural puncture, pneumonia was diagnosed in 2 (2,35 %) patients, pleural effusion – in 2 (2,35 %), empyema – in 1 (1,18 %), sulfur – in 1 (1,18 %), deep infection – in 1 (1,18 %). One patient (1,18 %) underwent a second operation due to the dislocation of the fixator.

Conclusions. In the postoperative period, it is recommended to avoid bending or rotating the body, limit participation in sports activities during the first 3 months after the operation. During the first 8 weeks, patients were recommended to perform breathing exercises with a small amplitude (for the prevention of respiratory complications), and 3 months after surgery – exercises to strengthen postural and abdominal muscles, to improve the amplitude of movements in the shoulder joints. The use of exercises helps to reduce the risk of post operative complications and improve the functional capabilities of patients with pectus excavatum in a shorter time.

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References

Nuss D, Kelly RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of Pediatric Surgery [Internet]. Elsevier BV; 1998 Apr; 33(4):545–52. Available from: https//doi.org/10.1016/s0022–3468(98)90314–1

Croitoru DP, Kelly RE, Goretsky MJ, Lawson ML, Swoveland B, Nuss D. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. Journal of Pediatric Surgery [Internet]. Elsevier BV; 2002 Mar; 37(3):437–45. Available from: https//doi.org/10.1053/jpsu.2002.30851

Hebra A. Minimally Invasive Repair of Pectus Excavatum. Seminars in Thoracic and Cardiovascular Surgery [Internet]. Elsevier BV; 2009; 21(1):76–84. Available from: https//doi.org/10.1053/j.semtcvs.2009.04.005

Watanabe A, Watanabe T, Obama T, Ohsawa H, Mawatari T, Ichimiya Y et al. The use of a lateral stabilizer increases the incidence of wound trouble following the Nuss procedure. The Annals of Thoracic Surgery [Internet]. Elsevier BV; 2004 Jan; 77(1):296–300. Available from: https//doi.org/10.1016/s0003–4975(03)01335–3

Krasopoulos G, Dusmet M, Ladas G, Goldstraw P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. European Journal of Cardio-Thoracic Surgery [Internet]. Oxford University Press (OUP); 2006 Jan; 29(1):1–5. Available from: https//doi.org/10.1016/j.ejcts.2005.09.018

Schalamon J, Pokall S, Windhaber J, Hoellwarth ME. Minimally invasive correction of pectus excavatum in adult patients. The Journal of Thoracic and Cardiovascular Surgery [Internet]. Elsevier BV; 2006 Sep; 132(3):524–9. Available from: https//doi.org/10.1016/j.jtcvs.2006.04.038

Aronson DC, Bosgraaf RP, van der Horst C, Ekkelkamp S. Nuss Procedure: Pediatric Surgical Solution for Adults with Pectus Excavatum. World Journal of Surgery [Internet]. Springer Science and Business Media LLC; 2006 Dec 1; 31(1):26–9. Available from: https//doi.org/10.1007/s00268–005–0779–1

Kim DH, Hwang JJ, Lee MK, Lee DY, Paik HC. Analysis of the Nuss Procedure for Pectus Excavatum in Different Age Groups. The Annals of Thoracic Surgery [Internet]. Elsevier BV; 2005 Sep; 80(3):1073–7. Available from: https//doi.org/10.1016/j.athoracsur.2005.03.070

Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB et al. Outcome analysis of minimally invasive repair of pectus excavatum: Review of 251 cases. Journal of Pediatric Surgery [Internet]. Elsevier BV; 2000 Feb; 35(2):252–8. Available from: https//doi.org/10.1016/s0022–3468(00)90019–8

Park HJ, Lee SY, Lee CS, Youm W, Lee KR. The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. The Annals of Thoracic Surgery [Internet]. Elsevier BV; 2004 Jan; 77(1):289–95. Available from: https//doi.org/10.1016/s0003–4975(03)01330–4

Ravitch MM. The operative treatment of pectus excavatum. The Journal of Pediatrics [Internet]. Elsevier BV; 1956 Apr; 48(4):465–72. Available from: https//doi.org/10.1016/s0022–3476(56)80075–9

Dzielicki J, Korlacki W, Janicka I, Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum — 6 years experiences with Nuss technique. European Journal of Cardio-Thoracic Surgery [Internet]. Oxford University Press (OUP); 2006 Nov; 30(5):801–4. Available from: https//doi.org/10.1016/j.ejcts.2006.08.004

Quigley PM, Haller JA, Jelus KL, Loughlin GM, Marcus CL. Cardiorespiratory function before and after corrective surgery in pectus excavatum. The Journal of Pediatrics [Internet]. Elsevier BV; 1996 May; 128(5):638–43. Available from: https//doi.org/10.1016/s0022–3476(96)80128–4

Fonkalsrud EW. Open Repair of Pectus Excavatum With Minimal Cartilage Resection. Annals of Surgery [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Aug; 240(2):231–5. Available from: https//doi.org/10.1097/01.sla.0000133116.16484.bb

Jaroszewski DE, Fonkalsrud EW. Repair of Pectus Chest Deformities in 320 Adult Patients: 21 Year Experience. The Annals of Thoracic Surgery [Internet]. Elsevier BV; 2007 Aug; 84(2):429–33. Available from: https//doi.org/10.1016/j.athoracsur.2007.03.077

Wang L-S, Kuo K-T, Wang H-W, Yang C-H, Chin T. A Novel Surgical Correction Through a Small Transverse Incision for Pectus Excavatum. The Annals of Thoracic Surgery [Internet]. Elsevier BV; 2005 Nov; 80(5):1951–4. Available from: https//doi.org/10.1016/j.athoracsur.2004.05.029

Krasopoulos G, Dusmet M, Ladas G, Goldstraw P. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. European Journal of Cardio-Thoracic Surgery [Internet]. Oxford University Press (OUP); 2006 Jan; 29(1):1–5. Available from: https//doi.org/10.1016/j.ejcts.2005.09.018

Kinesitherapy application features in patients after pectus  excavatum repai
Published
2019-11-01
How to Cite
1.
Fishchenko I, Kravchuk L. Kinesitherapy application features in patients after pectus excavatum repair. prmd [Internet]. 2019Nov.1 [cited 2020Jul.11];2(2):23-0. Available from: https://perioperative.org.ua/index.php/prtmdc/article/view/32
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