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“Open” pectus excavation repair. A. A transverse incision is placed below and well within the nipple lines at the site of the future inframammary crease.
The pectoralis major muscle is elevated from the sternum along with portions of the pectoralis minor and serratus anterior bundles. B. The correct plane of
dissection of the pectoral muscle flap is defined by passing an empty knife handle directly anterior to a costal cartilage after the medial aspect of the
muscle is elevated with electrocautery. The knife handle is then replaced with a right-angled retractor, which is pulled anteriorly. The process is then
repeated anterior to an adjoining costal cartilage. Anterior distraction of the muscles during the dissection facilitates identification of the avascular areolar
plane and avoids entry into the intercostal muscle bundles. C. Subperichondrial resection of the costal cartilages is achieved by incising the perichondrium
Source: Pectus Excavatum, Operative Pediatric Surgery
anteriorly. It is then dissected away from the costal cartilages in the bloodless plane between the perichondrium and the costal cartilage. Cutting back the
Citation:
MM, Azizkhan
RG, Allmen
D, Weber
TR.
Operative
Pediatric
Surgery;of2014
Available
at:the
http://mhmedical.com/
Accessed:
April
perichondrium
90° inZiegler
each direction
at its junction
with the
sternum
(inset)
facilitates
visualization
the back
wall of
costal cartilage. D. The
cartilages
29,
2017
are divided at the junction of the sternum with a knife with a Welch perichondrial elevator held posteriorly to elevate the cartilage and protect the
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McGraw-Hill
Education.
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(inset). The
divided
cartilage can
then be held
with an
Allis clamp, elevated, and divided laterally, preserving the costochondral junction with a
segment of costal cartilage. E. A sternal osteotomy is created above the level of the last deformed cartilage and the posterior angulation of the sternum,