Postoperative care for pectus excavatum

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on December 31, 2024
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Pectus excavatum surgery involves implanting a metal plate in the patient's body; however, this type of metal plate cannot be welded to normal bones or muscles. It is only fixable using stainless steel wires or sutures. Therefore, postoperative care is crucial. Good post-surgical care significantly reduces the chances of the metal plate shifting. We recommend that patients lie flat on their backs for 3 to 5 days after the surgery, avoid bending, twisting their bodies, or rolling over in bed for a week. For a month, it's important for patients to keep their bodies straight and stand flush against a wall. Since the chest will be quite painful after the surgery, standing against a wall helps the patient maintain a proper posture. Otherwise, due to the pain, the patient may stoop forward, resulting in a hunched posture, which is unappealing and not good for the spine. Within two months post-surgery, the patient should avoid bending over to lift heavy objects as this can lead to uneven distribution of force that may cause the metal plate to shift. Intense physical activities should be avoided for three months. The patient should ideally rest in a supine position and avoid external injuries and contact or impact sports like basketball, soccer, or football. Generally, the metal plate should be removed 2 to 3 years after the surgery depending on the circumstances, so regular clinic visits are necessary to monitor the situation of the plate. If the patient experiences difficulty breathing or chest pain after being discharged from the hospital, they should immediately go to the nearest hospital to have their chest x-rayed to check the status of the metal plate.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Is pectus excavatum hereditary?

In current medical technology, although no genes exclusively associated with pectus excavatum have been identified, there is evidence suggesting genetic predisposition when pectus excavatum coincides with other conditions. For instance, the incidence of pectus excavatum is significantly higher in patients with congenital connective tissue disorders, such as Marfan Syndrome, and is linked to certain genes within this syndrome. Additionally, patients with congenital diaphragmatic hernia also show an increased incidence of pectus excavatum. Moreover, the condition is more prevalent in patients, or children, who have subglottic airway stenosis or congenital bronchopulmonary dysplasia. Thus, these evidences confirm that pectus excavatum, as a disease in itself, is directly or indirectly related to congenital genetic factors, indicating a certain hereditary nature.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum is caused by what?

The specific etiology of pectus excavatum is not completely clear, but there are mainly two types of pectus excavatum: the simple type and the complex type, which means it is accompanied by other diseases. Currently, pectus excavatum is somewhat related to congenital genetic inheritance. This is because pectus excavatum is related to many connective tissue disorders, and many patients with congenital diaphragmatic hernias, psychogenic subglottic stenosis, and underdeveloped bronchopulmonary tissues also present with pectus excavatum. Although these diseases do not directly cause pectus excavatum, the reasons for the development of pectus excavatum, whether directly related to connective tissue disorders or not, are somewhat related to genetic factors. Therefore, it is currently considered that pectus excavatum is caused by genetic factors and inheritance.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum causes

The etiology of pectus excavatum is not fully clear yet, but it has been found that the incidence of pectus excavatum greatly increases among patients with connective tissue diseases, possibly related to the disruption of the balance between growth genes and inhibitory genes affecting the cartilage on both sides of pectus excavatum. Moreover, it is also found that the complication of pectus excavatum significantly increases among patients with Marfan syndrome (also a type of connective tissue disease) and Noonan syndrome. In children with congenital airway stenosis and bronchopulmonary dysplasia, the incidence of pectus excavatum also significantly increases. This suggests that the causes of pectus excavatum are directly or indirectly related to genetics and heredity, and regardless, the causes of pectus excavatum, both acquired and congenital, are directly related to genes and heredity.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Why can't people with funnel chest gain weight?

In clinical observations, we have found that children with pectus excavatum generally do not have as good nutrition as normal children, and are not as plump. This may be related to the deformity of the chest indentation. We know that the normal cross-section of the thorax on a CT scan is oval-shaped, with the heart and lungs located behind the sternum. In children with pectus excavatum, the sternum is compressed backward toward the spine, which deforms and even pushes the heart completely to one side. This compression of the heart limits the blood's ability to fully return to the heart, and may even prevent the valves from closing completely, leading to valve insufficiency. As a result, both cardiac and pulmonary functions are somewhat impaired. Therefore, 80% of children with pectus excavatum experience exercise intolerance, meaning they cannot run as well as normal children, which also indicates poorer physical fitness and, comparatively, a lesser appetite. Recent studies have found that children with pectus excavatum also have slightly weaker immune functions, and their digestive and absorption capabilities are not as good as those of typical children. Poor exercise capacity and digestive function ultimately lead to poorer nutrition in children with pectus excavatum, making them less plump than normal children.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum should go to which department?

Regarding the registration of patients or children with pectus excavatum, if it is for children and the consultation is only about the hereditary aspect of pectus excavatum or its etiology, consider registering at the pediatrics or child health department. It is also feasible to consult the genetics department. If the consultation is about treatment options for pectus excavatum, including methods of treatment, consider registering at the thoracic surgery department. Thoracic surgery can provide advice and methods for the treatment of pectus excavatum, including both surgical and non-surgical options. Of course, not all hospitals have a thoracic surgery department; generally, municipal third-level, first-class hospitals are equipped with thoracic surgery departments. If there is no thoracic surgery available, consider registering under the general surgery department.