Surgical Treatment in a Teenager With Severe Pectus Carinatum: A Case Report

BACKGROUND: Pectus carinatum is a deformity of the sternum and costal cartilages and ranks second in prevalence among the types of chest wall deformities. According to various studies, its incidence ranges from 8% to 20%. This study presents the clinical outcome of minimally invasive thoracoplasty aimed at correcting a complex chest wall deformity in a teenager with a severe and rigid form of pectus carinatum.

CASE DESCRIPTION: A 17-year-old patient underwent surgery for correction of severe pectus carinatum. The procedure was performed using a minimally invasive approach, with two T-shaped plates placed intra-extrapleurally and antesternally.

DISCUSSION: Correction of severe pectus carinatum often employs radical techniques that involve subchondral resection of the deformed costal cartilages, sternal osteotomy and/or mobilization of the xiphoid process, and resection of the lower end of the sternal body, followed by osteosynthesis. Such approaches may be associated with complications such as massive blood loss, subcutaneous hematomas, trophic skin disorders, sternocostal instability, and unsatisfactory cosmetic outcomes. In minimally invasive thoracoplasty, regardless of the type of sternocostal deformity, complications such as cardiac arrhythmias, major neurovascular structure injury, and osteosynthesis implant instability or migration may occur. They may be minimized by controlled correction of the chest wall using external devices or stable fixation systems. However, compared with submammary approaches in radical thoracoplasty, minimally invasive thoracoplasty offers the advantages of decreased tissue trauma, stable sternocostal integrity, and good cosmetic results.

CONCLUSION: This report presents the treatment outcome of a patient with severe pectus carinatum characterized by a sharp-angled, rigid deformity and ineffectiveness of comprehensive conservative treatment using modern bracing. The described minimally invasive surgical method offers clear advantages over radical approaches and may be recommended for certain patients with similar deformities.