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Correction of Pectus Excavatum by Custom-Made Silicone Implants: Contribution of Computer-Aided Design Reconstruction. A 20-Year Experience and 401 Cases

Chavoin, Jean-Pierre M.D.; Grolleau, Jean-Louis M.D.; Moreno, Benjamin; Brunello, Jérémie M.D.; André, Aymeric M.D.; Dahan, Marcel M.D.; Garrido, Ignacio M.D., Ph.D.; Chaput, Benoit M.D.

Plastic & Reconstructive Surgery: May 2016 - Volume 137 - Issue 5 - p 860e–871e
doi: 10.1097/PRS.0000000000002071
Reconstructive: Trunk: Original Articles

Background: In the absence of demonstrable functional impairment, pectus excavatum is merely a congenital deformity, albeit with a marked psychological impact. Many patients do not wish to undergo thoracic remodeling operations, which are invasive and do not clearly result in respiratory or cardiac improvement.

Methods: From 1993 to 2015, the authors designed 401 custom-made silicone implants to treat funnel chests. Before 2007, implants were made from plaster chest molds. Beginning in 2007, three-dimensional reconstructions were made from computed tomographic scans by computer-aided design. The authors prospectively recorded all assessments and follow-up data since 1993. Preoperative and postoperative photographs of two random groups of 50 patients were analyzed, in a blinded manner, by two surgeons independently. Intraoperative and postoperative complications, clinical outcomes, patient satisfaction, and quality of life were evaluated.

Results: One infection and three hematomas were recorded. Periprosthetic seroma was evident in all cases. Patients rated the cosmetic outcomes of computer-aided design implants significantly higher than those of the earlier implants made using plaster molds (p = 0.030). Malformations were better corrected in the computer-aided design group (86 percent) than in the plaster group (72 percent) (p = 0.038). Patient satisfaction was higher in the former group (p = 0.011). Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements, both socially and emotionally.

Conclusions: Correction of pectus excavatum using a computer-aided design silicone implant fulfils aesthetic and psychological demands. The technique is simple and reliable and yields high-quality results. In the medium term, the approach may render invasive techniques obsolete. These operations remain risky and of doubtful functional utility.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Toulouse, France

From the Service de Chirurgie Plastique et Reconstructrice, CHU Toulouse Rangueil; and the Service de Chirurgie Thoracique, CHU Toulouse Larrey.

Received for publication June 27, 2015; accepted December 17, 2015.

Disclosure: The authors have no financial interest in any of the products or devices mentioned in this article.

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Benoit Chaput, M.D., Plastic and Reconstructive Surgery Unit, CHU Rangueil, 1, Avenue Jean Poulhès, Toulouse, France, benoitchaput31@gmail.com

©2016American Society of Plastic Surgeons