Pectus excavatum is the most frequently observed type of chest malformation in children. The condition is also known as “Funnel chest” or “Sunken chest”. It's a chest wall deformity involving multiple ribs and the breastbone growing inwards. That gives the chest a concave appearance that looks sunken or caved-in.
What is Pectus Excavatum?
It’s a genetic condition that can be passed down through heredity. About 40% of children diagnosed with the condition report having one or more relatives with the condition.
Pectus excavatum is observed more commonly in males and isn’t always visible upon birth. The condition becomes more evident as the child grows, with the inwards curvature becoming more pronounced.
The deformity can range from mildly odd-looking to a severely sunken chest. Causes for Pectus excavatum are not entirely understood. During normal development, the ribs and breastbone grow outward at the anterior of the chest.
Pectus excavatum is believed to result from abnormal growth of the cartilage that connects the ribs to the sternum. This excessive growth pulls the sternum inward, resulting in pectus excavatum.
Often, children diagnosed with pectus excavatum also suffer from one or more of the following conditions:
Even though it’s a birth defect, signs and symptoms of pectus excavatum typically appear as the child nears puberty. Mild cases only present with a slight dip in the chest wall that’s barely obvious. A child may not show any symptoms during normal daily activities but get tired and out of breath quicker than his peers.
In more extreme cases, pectus excavatum can create pressure on the lung and heart. That could compromise the working of vital functions, leading to a host of other issues such as
The diagnostic process will depend on your child’s overall health and the presence of other defects. The doctor will perform a physical exam and might recommend one or more of the following tests if pectus excavatum is suspected
Children's bodies are constantly developing and growing, each unique from the other. That’s why when it comes to pectus excavatum, pediatricians often take the “wait and see” approach. Given, of course, that the deformity is not affecting cardiopulmonary function.
Complications from pectus excavatum can vary widely from infants to teenagers. That’s why it's crucial to regularly monitor any suspected cases before symptoms develop into any severe complications.
Scheduling regular appointments with a specialist is a great preventive measure for all children diagnosed with the condition.
Pectus excavatum can be surgically treated if symptoms prevail to improve a patient’s breathing and cardiac function. That’s done by repositioning the sternum to a more natural, outward position. Once the breast bone is not bending inwards, pressure on the heart and lungs eases up. That allows enough room for the organs to function more effectively.
Of course, addressing any psychological aspects of the condition is also important. Pectus excavatum often peaks when children are approaching puberty and already going through many challenges regarding their self-image. Surgery is less invasive in most cases and dramatically improves the physical appearance of the chest.
Surgical options available to your child will vary on several factors. Primarily these procedures are performed for correcting pectus excavatum:
The Nuss Procedure
A camera is guided through the chest cavity, and two small slits are made on each side of the chest. The next step is to insert an arched steel bar just under the sternum.
The curvature of these steel bars is modified for each patient, depending on their deformity. It can be left in place for up to 3 years while it slowly reshapes the chest depression.
The Ravitch Procedure
This is the more traditional and invasive surgical option for correcting pectus excavatum. It can take any of these two approaches:
An incision is made on the front of the chest, and cartilaginous parts of the overgrown ribs are cut and removed. The sternum is then pulled forward, away from the heart and lungs, and into the natural plane of the chest wall. A metal plate and screws then securely adhere the sternum into its new position.
With the second method, a small metal bar is placed behind the sternum. It's left in place from 6 months up to a year. Removal of the bar is done in a simple outpatient procedure once the chest takes on a more normal appearance.
Vacuum Bell Device
An effective way to treat milder pectus excavatum in young patients. A bell-shaped instrument connected to a pump is placed on the child’s chest. It pumps the air out, creating a vacuum that brings the chest forward.
Doctors often recommend physical therapy and exercises in addition to all these correctional methods. The goal is to strengthen the chest muscles and improve your child’s posture.
Help Your Child Overcome Pectus Excavatum
If you suspect pectus excavatum in your child, the best time to take action is now. Book a free consultation today with Align clinic to discuss treatment options to correct and manage the condition.
Pectus Carinatum, the condition more commonly known as pigeon chest, is a relatively rare birth defect. The 1 out of every 1500 children that suffer from the condition is born with an abnormally shaped chest. The reason is an anomaly in the chest wall that causes the child's breastbone to protrude outwards to an abnormal degree.
The deformity becomes more prominent as the child grows, though it is present from birth. Pectus carinatum is not usually harmful or deadly. It doesn't cause any organ damage or hinder their normal functioning in any way.
Asthma and respiratory issues are reported in some extreme cases, in addition to soreness in and around the chest area. The disorder certainly affects the physical appearance of the child and thus, can have psychological implications as the child grows. If left untreated, it can cause health issues later in life.
Treatment Options for Pectus Carinatum
Recent studies conducted regarding the illness suggest that it might occur more often than we initially realized in the past. The treatment path for your child will often vary on several factors such as:
If the illness has developed into its later stages, then surgery is usually used as a last resort option. Let’s look at some ways pectus carinatum is treated:
The Ravitch Technique
Up till a few years ago, the standard treatment option for pectus carinatum was “the Ravitch technique”. That’s an invasive surgical correction that involved making an incision across the chest and cutting away the defect-causing cartilage.
All major surgeries come with inherent risks. There can also be serious psychological and physiological complications for the minor it was performed on.
The Abramson Technique
Another way to treat the deformity with a less invasive approach than the Ravitch technique is The Abramson procedure. This is a minimally invasive surgical correction method. The procedure is comparatively recent, and much less aggressive treatment for pectus carinatum.
A metal bar is implanted in the presternal, extra-thoracic region during the surgery. The bar stays in place for a period of up to 2 years in an attempt to lessen the presentation of pectus carinatum.
Pectus Carinatum Bracing
Chest wall bracing is a great option for correcting pectus carinatum in children. Pectus carinatum bracing can be very effective if the illness is caught early enough. It’s generally prescribed for children who are still in the growing phase.
The pectus carinatum brace can help correct the abnormality by gently placing pressure on the chest to re-shape the breastbone. The pectus carinatum brace is a lightweight and wearable device custom-fitted to each child’s specific size.
How It Works
The mechanism behind the pectus carinatum brace is comparable to how braces work to straighten teeth gently. The chest bracket is tailored to the child’s size and pushes the cartilage inwards to align it better with the chest cavity.
Since the chest cartilage is more malleable in kids than other bones, the technique is generally quite effective in correcting the visible appearance of the chest wall.
The pectus carinatum brace rarely causes any problems for the child. If the child feels too much pressure or shows sensitivity towards the tightness, you can give a low dose of acetaminophen once you clear it with your pediatrician. A child’s irritation with the bracing is quite understandable and differs from physical pain or discomfort.
Finding the right balance between maintaining enough pressure to straighten the malformed curve while keeping the child comfortable can be challenging. The child’s doctor will schedule regular visits to monitor progress and make any needed re-adjustments to the brace.
Duration of Wear
Bracing typically takes place in two phases. The first is more aggressive with the child keeping the brace on for 24 hours daily. That continues till the abnormality has been corrected. The second requires the child to wear the brace only at night, anywhere from 8-12 hours until axial growth is complete.
The pectus carinatum brace is unnoticeable under regular clothing. An important plus for self-conscious children who want to participate in activities with their peers.
In most typical cases, the child will need to wear the pectus carinatum brace anywhere from six to twelve months. That duration can be longer or shorter depending on the severity of their case. At least 8-12 hours a day of wear is a must for the brace to be effective. Doctors allow the occasional break for activities such as
The success rate of the pectus carinatum brace is quite promising. Around 65-80 % of long-term patients fully recover with bracing as the only treatment administered.
Bracing is a risk-free treatment option that can have a significant impact on boosting your child's confidence.
Being vigilant in wearing the brace for the recommended daily periods is one of the best things a patient can do for recovery. Failure of pectus carinatum bracing as a treatment option is due mainly to non-compliance with the doctor’s instructions.
Get Your Child Fitted for the Pectus Carinatum Brace Today
Pectus carinatum can be a scary diagnosis to come to terms with. The good news is that the sooner you start treatment, the better your child’s chances of making a full recovery. To learn more about your child’s condition and treatment options, log on to the Align clinic website now and book an appointment.
Above-the-knee amputation, or AKA for short, implicates the surgical removal of the leg from or above the knee. Typically done by cutting through the thigh tissue and femoral bone completely. An above-the-knee amputation includes removing the leg from any point above the knee.
It’s a major surgical procedure with far-reaching implications for your physiologic and psychological health.
The more you educate yourself about the after-care, above-the-knee prosthetics options available to you after AKA, the better you can make decisions about your health and well-being.
Causes for Above The Knee Amputation
Above-the-knee amputation is considered major surgery. The procedure is only carried out in the absence or failure of other options to salvage the limb. Most often, the surgery is done in emergencies to save the patient’s life when prospects of recovery of the leg are null. There can be many reasons for an above-the-knee-amputation surgery, such as
You may or may not have gotten a chance to prepare mentally before the surgery as it’s often carried out in emergencies as a life-saving measure. While the psychological implications of losing a limb are certainly deep, it helps to remember that you are not without control.
Your Surgical Site
Depending on the severity of the disease or trauma, the incision site will have sutures or staples. These will be removed after a month or six weeks, again, depending on how well the incision heals. The surgical site will feel raised or thickened, that’s quite normal. Immediately after surgery, your leg might be elevated to help decrease swelling.
Phantom pain, swelling, tightness, and pain are common after all kinds of amputation surgeries.
Depending on how your healing goes and how well you respond to medication, your stay can last anywhere between 1 to 2 weeks. During this time IV medication will be administered for pain management and to mitigate the risk of clots forming.
Once the first 24 hours pass post-surgery, your doctor may suggest bringing the leg down. Gently rolling over to lie face-down is also commonly prescribed to avoid tightening at the hip.
Incision Care Tips
Taking good care of yourself post-surgery is one of the main things you can do to be out and about as soon as possible. Good self-care practices after the procedure increase above the knee prosthetic options available to you.
While post-op is definitely one of the most trying times you can go through, there are things that can help increase your comfort levels and manage pain better. Here are some post-surgical tips for above-the-knee amputees:
Using your compression stocking as prescribed by your medical care providers is one of the most important things you can do for your healing. That’ll help gently mold your leg into the optimal shape suitable for use of above the knee prosthetics.
It will also control swelling at the incision site. Typically, fitting for the compression stocking will be done before you leave the hospital post-op. You can start using the sock after 48 hours of the surgery once you clear it with your doctor.
Getting Fitted for Above The Knee Prosthetics
The process of adjusting to life without your limb will start the moment you open your eyes post-op. While it's definitely a difficult adjustment, it helps to remember that you have great options available for above the knee prosthetics.
The first piece of equipment you will use to help you maintain mobility after surgery is the Immediate Post-Operative Prosthesis (IPOP). Use this to start getting around as much as your doctor recommends. The IPOP also helps you heal by
Here is a breakdown of getting fitted for your above the knee prosthetic:
The first step will be getting a custom-made liner that’ll keep your limb securely cushioned. That’ll help attach your above the knee prosthetic to your limb and keep you comfortable while using your prosthesis.
The next step is getting your limb cast to help find the closest fit for your unique needs and limb shape. Once the cast is done, you’ll try on a few diagnostic socks to ensure optimal alignment between your limb and prosthesis. Once you finalize the socket that fits the best and feels comfortable, posture and gait training can be started.
The final step will be to weigh your options and make a final choice about which above the knee prosthetic will best suit your activity level and lifestyle. You’ll get plenty of help during this stage to make a well-informed decision. Contact Align Clinic now and we would be happy to guide you through any questions you may have.
Start Your Journey To Recovery Today
Amputation is difficult, and it’s crucial to go easy with yourself and take your healing one day at a time. Our professionals at Align Clinic know just how difficult this phase can be. Book an appointment with our representative today to discover all options available to you.
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