• Journal of Chest Surgery
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• 제11권3호
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• pp.246-252
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• 1978

A three year and seven month old girl with moderate depression deformity of the sternum associated with a huge well defined homogenous hazy mass density of the upper half of the right hemithorax on plain chest x-ray had developed, exertionaI dyspnea (Figs1, 2 and 3). Correction of the funnel chest was carried out with modified Ravitch procedure and resection of the intrathoracic cystic mass was performed through an anterolateral thoracotomy incision in one stage operation satisfactorily (Figs. 7 and 8). On exploration, the mass, $15{\times}12{\times}10$cm in size, was connected to the bronchus at 1cm a bove the carina by a stalk (Fig. 4). The outer surface showed abundant vasculature. The specimen was filled with mucoid material; the inner surface was much trabeculated. glistening and smooth (Fig. 5 and 6). yficroscopically, the cyst was lined with simple or pseudostratified ciliated columnar epithelium. The cystic wall was composed of loose fibrous connective tissue, muscle layers, cartilages with some lymphocytic infiltration (Fig. 9). Isolated cases of funnel chest deformity and congenital bronchogenic cystic disease are not uncommon; however, the assocbtion of the two conditions is yery rare. Therefore. report and review of the literature was done.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.346-351
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• 2007

Purpose: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander. Methods: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction. Results: All patents were satisfied with the results and there occurred no specific complications. Conclusion: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.739-742
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• 2008

Purpose: Breast augmentation is one of the common procedures in plastic surgery today. The shape, size and insertion plane of the implant is decided preoperatively by physical examination of the breast. Pectus excavatum is one of the most common anomalies of chest wall, characterized by a depression of the anterior chest wall. For patients with a mild type of pectus excavatum, the main purpose of the treatment is aesthetic rather than functional improvement. Two most surgical treatment options for skeletal deformity are the Ravitch technique and minimally invasive Nuss repair. Other options for soft tissue repair are implant insertion and autologous soft tissue augmentation. We performed a surgical operation with Nuss procedures and breast augmentation for a patient with mild pectus excavatum and hypoplastic breast. Methods: A 32 year-old female was presented with hypoplastic breast. Preoperative chest CT was performed, showing pectus excavatum. After Nuss procedure, we inserted saline implant(275 cc textured round breast implant, moderate profile) submuscularly to restore adequately projected breast. Results: Patient's postoperative course was uneventful without any complication. After 6 months of follow-up period, the patient had an excellent result, with high patient satisfaction and no complications. Conclusion: For patients with a mild type of pectus excavatum, who do not have cardiopulmonary symptoms and requires for aesthetic improvement, this simple approach with Nuss procedure and breast augmentation achieves excellent aesthetic correction with low complication rate and high patient satisfaction.

• Clinical and Experimental Pediatrics
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• 제58권1호
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• pp.37-40
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• 2015

The presence of a single coronary artery is a rare congenital anomaly; such patients often present with severe myocardial ischemia. We experienced the case of a 13-year-old girl with the right coronary artery originating from the left circumflex artery. She visited our Emergency Department owing to severe chest pain; her cardiac enzyme levels were elevated, but her initial electrocardiogram (ECG) was normal. Echocardiography showed normal anatomy and normal regional wall motion. When she presented with recurrent chest pain on admission, the ECG showed significant ST-segment elevation in the left precordial leads and inferior leads with ST-segment depression in aVR lead, suggesting myocardial ischemia, and her cardiac enzyme levels were also elevated. We performed coronary angiography that showed a single right coronary artery originating from the left circumflex artery without stenosis. We confirmed the presence of a single coronary artery using coronary computed tomography. In addition, the treadmill test that was performed showed normal results. She was discharged from the hospital without any medications but with a recommendation of a regular followup.

• Journal of Chest Surgery
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• 제54권3호
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• pp.186-190
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• 2021

Background: Pre-lifting of the sternum marked a major turning point in pectus excavatum repair. The author developed the crane technique in 2002 and successfully applied it to more than 2,000 cases using sternal wire stitching. However, blind sternal suturing limited the use of the wire-stitch crane. We propose a novel screw for sternal lifting as a new tool for the crane technique. Methods: We developed a screw system strong enough to withstand the pressure needed for sternum lifting. The screw was designed to have a broader thread to hold the bony tissue securely. The screw's sustaining power was tested using the torsion, driving torque, and axial pull-out tests in a polyurethane block and ex-vivo porcine sternum. Results: The screws were easily driven into the sternum, and the head of the screw was connectable to the table-mounted retractor. In the torsion test, the 2° offset torsional yield was 4.53 N·m (reference value, 1 N·m). In the polyurethane block driving torque test, the maximum torque was 0.98 N·m (reference value, 0.70 N·m). The axial pull-out test was 446 N (reference value, 100 N). The maximum pull-out resistance in the ex-vivo porcine sternum model was 1,516 N. Conclusion: The screw crane was strong enough to sustain the chest wall weight to be lifted. Thus, the screws could effectively replace the sternal wire stitching in crane pre-lifting of the sternum. We expect that application of the screw-crane will be easy and that it will improve the safety and success rate of pectus repair surgery.