Outcomes From a Nurse Practitioner Led Dynamic Compression System Bracing Program for Pectus Carinatum.

BACKGROUND: Dynamic compression system (DCS) is often effective at treating pectus carinatum (PC). However, some patients will fail therapy. This study reports outcomes from a nurse-practitioner led bracing program, and evaluates what factors are predictive of successful therapy. METHODS: We performed a retrospective cohort study involving all patients treated with DCS bracing at our institution between February 2018 and February 2022. Patients with at least three visits were included. The primary outcome was achieving neutral chest. Factors considered potentially predictive included patient age, sex, initial pressure of correction (PIC), and the change in pressure of correction between the first two visits (deltaPC1). A Cox proportional hazards model was used for analysis, and Kaplan-Meier analyses estimated the median time to correction. RESULTS: 283 patients were evaluated. The median age was 14 (IQR 12-15), the majority were male (90.1 %) and white (92.6 %). The median PIC and deltaPC1was 4.13 PSI (IQR 3.17-5.3), and 1.34 PSI (IQR 0.54-2.25), respectively. 117 patients achieved correction. The median estimated time to correction was 7.5 months (95 % CI 5.9-10.1). In the final Cox model, greater deltaPC1 was associated with increased risk of correction (HR: 2.46; 95 % CI 2.03-2.98), and increased PIC was associated with decreased risk of correction up to one year of therapy (0-3 months HR 0.62, 95 % CI 0.50-0.78; 3-12 months HR 0.62; 95 % CI 0.45-0.85). CONCLUSIONS: DCS bracing administered by advanced care providers in collaboration with surgeons can effectively treat PC. The deltaPC1 and PIC are the factors most predictive of successful therapy. LEVEL OF EVIDENCE: Level III.

Negative Pressure Wound Therapy in Surgical Site Infections of Sternotomy Wounds - A Case Series Study in Neonates and Infants.

This case series, performed by the department of plastic and reconstructive surgery at our institution, reports the management of sternal wound dehiscence in newborns and children after cardiac surgery with the help of a negative pressure wound therapy treatment system. Three neonatal patients with poststernotomy wound problems were treated with a negative pressure wound therapy (VAC) system. Negative pressure therapy was started with negative pressure at 50 mm Hg, continuously. All children achieved healing of the sternal wound and a subsequent closure after a mean length of treatment of 33 days (range, 21-49 days). In conclusion, negative pressure therapy with pressure adjusted to lower values as compared with adults in combination with radical surgical debridement was found to be safe and effective, as well as being tolerated well in neonatal and infant patients with extensive or localized poststernotomy wound dehiscence.

Pectus excavatum ­ Correção cirúrgica utilizando tala externa de poliuretano fabricada com tecnologia de impressão 3D / Pectus excavatum ­ Surgical correction, using polyurethane external splint made with 3D printing technology

Objetivou-se relatar o emprego de uma tala externa confeccionada com material de poliuretano e cobertura interna de neopreme na reparação cirúrgica do pectus excavatum em um felino jovem. O felino apresentava deformidade anatômica congênita na região do externo e sinais clínicos respiratórios. Imagens avançadas de tomografia foram utilizadas para moldar a tala impressa com tecnologia tridimensional. Esta alternativa possibilitou melhor planejamento cirúrgico e, com isso, conforto para o paciente, além da qualidade própria do material de poliuretano que é levemente maleável, o que permitiu melhor moldagem e expansão torácica durante a respiração. A tala se provou resistente o suficiente para suportar a tração ocasionada pelos fios de sutura e possibilitou o reposicionamento adequado do osso esterno ao mesmo tempo que se mostrou confortável e acarretou mínimas lesões ao paciente.

The aim of this paper was to report the use of an external splint made of polyurethane material and internal neopreme covering in the surgical repair of a pectus excavatum in a young feline. The feline exhibited a congenital anatomical deformity in the external region and clinical respiratory signs. Advanced CT images were used to shape the 3D-printed splint. This alternative allowed better surgical planning and, therefore, comfort for the patient, this because to the quality of the polyurethane material, which is slightly malleable, and allowed for better molding and chest expansion during breathing. The splint proved to be strong enough to withstand the traction caused by the suture threads and allowed the proper repositioning of the sternum, at the same time it was comfortable and caused minimal injuries to the patient.

Free DIEP and ALTP flaps in repairing skin and soft tissue defects in chest wall: A case report / 吉林大学学报(医学版)

Objective: To summarize the therapeutic effect of free deep inferior epigastric perforator (DIEP) flap and anterolateral thigh perforator (ALTP) flap in repairing skin and soft tissue defects in chest wall tumor resection.Methods: One old male patient with malignant fibrous histiocytoma of chest wall in China-Japan Union Hospital received operation,and the tumor was extendedly resected.The remaining chest wall defects were 10 cm×10 cm and 18 cm×14 cm,respectively.Free DIEP and ALTP flaps were used to repair the defects,and vascular pedicle was anastomosed with internal mammary artery and thoracic lateral artery,respectively.Results:After operation,the donor area was sutured directly,and two flaps survived with good appearance.The skin of ALTP flap was flatter than that of DIEP flap,and the texture and color of skin were close to those around chest wall.Conclusion:Free DIEP and ALTP flaps are ideal choice for repairing skin and soft tissue defects after resection in the male patient with chest wall tumor.

Chest wall reconstruction using a combined musculocutaneous anterolateral-anteromedial thigh flap.

We present a massive 25 cm × 20 cm chest wall defect resulting from resection of recurrent cystosarcoma phyllodes of the breast along with six ribs exposing pleura. The chest wall was reconstructed with a Prolene mesh-methylmethacrylate cement sandwich while soft tissue reconstruction was carried out using a combined free anterolateral-anteromedial thigh musculocutaneous flap with two separate pedicles, anastomosed to the thoracodorsal and thoracoacromial vessels respectively. We explain our rationale for and the advantages of combining the musculocutaneous anterolateral thigh flap with the anteromedial-rectus femoris thigh flap.

Chest wall reconstruction with polycaprolactone reinforced with degradable chitin short fiber in dogs / 第二军医大学学报

Objective: To investigate the application of a novel degradable biomaterial-short chitin fiber reinforced polycaprolactone (PCL) as a chest wall prosthesis, so as to assess its feasibility in clinical chest wall recomstruction. Methods: Two kinds of chest wall defects models (10 cm×10 cm) were established in the present study, namely, group I with simple rib resection (n=2) and group II with full-thickness resection (the ribs, rib periosteum, intercostal muscle, parietal pleura, n=8). The defects in both groups were repaired with short chitin fiber reinforced PCL plates. The implanted chest wall prosthesis and the regeneration of the chest wall tissue were dynamically observed postoperatively by X-ray, CT scanning, and histological examinations. Results: No operative/peri-operative death was observed in both groups; flail chest and paradoxical movement were not found in dogs. In group I neogenetic bone tissues were found growing along the surface of chest wall prosthesis and new ribs appeared between prosthesis and parietal pleura. In group II artificial chest wall prosthesis integrated tightly with chest wall ribs and muscle tissues around. Conclusion: Degradable chitin fiber reinforced PCL has fine biocompatibility and can provide effective support for chest walls, making it a promising biomaterial for chest wall reconstruction.