NEWS

By LESLIE H. LANG
UNC-CH School of Medicine

CHAPEL HILL -- In a medical first for North Carolina, pediatric surgeons at the University of North Carolina at Chapel Hill have corrected a common chest-wall deformity called "funnel chest" by using a simpler, new operation.

An 18-year-old male patient at UNC Hospitals has undergone improved treatment for pectus excavatum, a condition that occurs roughly once in every 2,000 U.S. births.

Pectus excavatum displaces the sternum, or breastbone, rearward and leaves a deep groove in the chest, making it appear caved in. Stooped shoulders and poor posture exaggerate the effect, which carries both a physiological and a psychological burden, says Dr. Don K. Nakayama, professor and chief of pediatric surgery at the UNC-CH School of Medicine.

"The physiologic effect is that the chest doesn’t expand normally," he said. "While the children are able to breathe and measure normal in pulmonary function studies, most complain of easy fatigability and shortness of breath. In gym class, these may be the kids toward the back when they’re running around the track. And during summer, they’re the kids with T-shirts on when they go swimming."

Nakayama said children commonly become self-conscious about the appearance of their chest.

"All you have to do is look at newsstand magazine racks and you’ll see how important chest appearance is to boys and girls," he said. "So this condition is very discomfiting, particularly when the child reaches adolescence. They become very self-conscious."

The new surgery, developed at Children’s Hospital of the King’s Daughters in Norfolk, Va., takes about 90 minutes, compared to the four hours required for the traditional procedure.

In the older operation, cartilage is removed from the ribs where they attach to the sternum. Muscle also is removed. The sternum is levered upwards and held in place with a flat steel bar, which rests on each side of the chest wall. The bar remains in place for six months, much like an orthopedic pin, and is removed in a second operation.

In the new procedure, however, neither muscles nor cartilage are removed.

"We put in a much thicker and longer bar underneath the sternum," Nakayama said. "The bar is curved to conform to the desired shape of the chest and just holds things in place."

After the traditional operation, patients are restricted in activities involving arm and chest wall muscles for at least six weeks. Vigorous activity may resume after 12 weeks. But because muscle is not removed in the new procedure, such activity can be resumed as desired.

For both procedures, post-operative recovery time and pain are about the same, Nakayama said

"But as bones conform to the desired configuration, then it becomes less painful," he said.

Although Nakayama’s first Tar Heel patient was 18, children aged 6 to 10 probably are better candidates because their bones are more malleable, thereby increasing the chances for a good correction, he said.

"I believe the new procedure will replace the old one for pectus excavatum," he said. "It’s a shorter, less radical operation and should require shorter hospitalization."

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Note to media: Dr. Don K. Nakayama can be reached at 919-966-4643.

School of Medicine contact: Lynn Wooten, 919-966-6046, or lwooten.est1@mail.unch.unc.edu.