Surgical treatment

PECTUS UP: DOES NOT HINDER THE NORMAL DEVELOPMENT OF THE RIBCAGE

Ventura Medical Technologies has developed the Pectus Up. It is a new minimally invasive surgical technique for the repairing treatment of the Pectus Excavatum.

The Pectus Up is a surgical kit and there are currently two models, the Pectus Up Surgery Kit 1 and the Pectus Up Surgery Kit 2.

The two kits offer a similar therapeutic solution, although with kit 2 the indication of this treatment is extended to a more extensive type of patients.

The Pectus Up consists of an implant and a set of tools used in a new method that is very minimally invasive and therefore not very painful, which entails a short period of convalescence and without serious complications.

The procedure is as follows: the Pectus Up implant is placed on top of the sternum, at the subpectoral level, in the most sunken area of ​​the chest. Subsequently, by means of an elevation system, the sternum is lifted to the desired position and is fixed with the implant.

This new method for the surgical treatment of the Pectus Excavatum, is very minimally invasive and implies important advantages over other currently existing surgical techniques. The most important are: being an extrathoracic surgical procedure, with a short duration of the intervention which reduces the risk of affecting the internal organs and the appearance of serious complications; not being very painful intervention with a low consumption of analgesics; requiring short hospital stays; having a short recovery period; and not requiring intensive care.

Patients with Pectus Excavatum who have been treated with the Pectus Up system highlight this process for being less painful, for the fast incorporation into daily life and a short hospital stay. This is due to the fact that the patient is subjected to a minimally invasive and not very complex procedure.

STEP BY STEP surgical procedure

Below we describe, step by step, the surgical technique for the treatment of Pectus Excavatum with the Pectus Up Surgery Kit 1 and the Pectus Up Surgery Kit 2.

PROCEDure with PECTUS UP SURGERY KIT

KIT 2

1. Make the incision in the skin: A horizontal incision is made in the area of ​​maximum depth of the Pectus Excavatum. The measurement of the incision would be between 3 and 4 cm.

2. Implant verification: Creation of a subpectoral space big enough to place the implant under it. Verify that the implant fits correctly in the pocket and make a mark is with an electrosurgery unit at the center point of the plate hole to establish the elevation point. The implant is then removed.

3. Insertion of the sternal plate: The plate is placed on the sternum so that its central hole coincides with the mark and it is fixed with fixation screws to the sternum.

4. Insertion of a patella screw: A patella screw is threaded in the central part of the sternal plate that will enable its adjustment to the elevator system. This screw manages to correct the asymmetry as the sternum is pulled.

5. Implant placement: The implant is placed in the subpectoral space, so that its central hole coincides with the point marked with the electrosurgery unit.

6. Insertion of the elevator system: The two components of the elevator system (power screw and power thread) are assembled to allow rotation between them and thus enable the elevation of the sternum. Once assembled, the ball at the bottom of the power screw is inserted into the ball screw.

7. Elevation of the sternum: The power thread is rotated around the power screw until it touches the plate. Here on, gentle rotation is continued using a flat key, allowing a progressive and controlled elevation of the sternum. Each full turn of the thread is the equivalent to 2mm elevation. From the CT measurements, the rotations are already planned.

8. Place the interplate screws on the implant: Once the sternum has been raised to the desired position and the sternal plate fits perfectly with the implant, place the screws in the side holes of the central area of ​​the implant. These screws will fix the implant to the sternal plate.

9. Remove the elevation system and the patella screw: Once the implant is fixed to the sternal plate, the power thread is unscrewed, the power screw is removed from the patella screw and eventually the patella screw is unscrewed from the plate sternal.

10. Suture of the incision. The suture of the pectorals and the skin is performed. It is recommended to use a drain for a maximum of 48 hours to avoid seroma.

KIT 1

1. Make a hole in the sternum: A horizontal incision is made in the area of ​​maximum depth of the Pectus Excavatum. The measurement of the incision would be between 3 and 4 cm. Then, a hole is made in the sternum using a drill, with a stop to ensure that it does not exceed the thickness of the sternum (previously measured with Computerized Axial Tomography – CAT).

2. Implant verification: Creation of a subpectoral pocket big enough for the implant to fit under it. It is verified that the implant fits correctly in the pocket and that the central hole of the plate coincides with the hole previously made in the patient’s sternum. The implant is then removed.

3. Cerclage: The surgeon performs a rib cerclage. With a periosteal elevator, the area of ​​the ribs is deperiostized, where sutures that will surround the plate and join it to the ribs, will be placed.

4. Implant insertion: The implant is eventually inserted in the subpectoral pocket, so that its central hole coincides with the area where the hole was made in the sternum.

5. Insertion of an expander screw: In the central hole of the plate we will insert a plug. Once placed, an expander screw is threaded inside, allowing its expansion and increasing the taco-sternum grip.

6. Insertion of the elevator system: The two components of the sternal elevation system (power screw and power thread) are assembled to allow rotation between them and thus enable the elevation of the sternum. Once assembled, the power screw is threaded into the expander screw.

7. Sternum lift: The power thread is rotated around the power screw until it is in contact with the plate. Here on, gentle rotation is continued using a flat key, allowing a progressive and controlled elevation of the sternum. Each full turn of the thread equals 2mm elevation. From the CT measurements, the rotations are already planned.

8. Place the sternum fixation screws: Once the sternum has almost been raised to the desired position, small holes are made in the sternum through the upper and sideholes of the plate, attached to the central hole of the plate, to accommodate the cortical fixation screws. The sutures are then tightened, creating the definitive fixation of the implant.

9. Remove the lifting system. Once the implant is fixed, the power thread is unscrewed, the power screw is unscrewed from the expander screw and finally the expander screw and plug are removed.

10. Incision suture. The suture of the pectorals and the skin is performed. It is recommended to use a drain for a maximum of 48 hours to avoid seroma

plate REMOVAL

The implant will be removed between 3 and 5 years after the intervention, although it can remain for longer. If the patient has any discomfort or any type of skin perception at an aesthetic level, he/she can agree with the surgeon to remove it before this period.

If possible, the implant should not be removed before two and a half years.

PlaTE removal procedure

  • Supine position, balanced general anesthesia, orotracheal intubation or laryngeal mask.
  • Incision over old scar; dissection by layers until the Pectus Up is identified; extension of the dissection towards the wings of the implant; removal of screws and other fixing elements; release of the Pectus Up from scar tissue and removal of all the implanted material; layer closure with absorbable material and skin closure with non-absorbable intradermal suture, which will be removed after ten days.
  • On rare occasions, a chest tube may be considered if the surgeon deems it necessary.

Cuidados postoperatorios del retiro de la placa

  • Oral analgesia prescribed with conventional drugs (Ibuprofen or Paracetamol).
  • Once the implant is removed, the patient can lead a normal social, academic and professional life.

All these recommendations are general and will always depend on the evolution of each patient, being always subject to the criteria of the surgeon who performed the surgical intervention.

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