{"id":30281,"date":"2026-07-08T08:23:40","date_gmt":"2026-07-08T08:23:40","guid":{"rendered":"https:\/\/pectusup.com\/?p=30281"},"modified":"2026-07-08T08:25:05","modified_gmt":"2026-07-08T08:25:05","slug":"the-history-of-pectus-excavatum-treatment","status":"publish","type":"post","link":"https:\/\/pectusup.com\/en\/the-history-of-pectus-excavatum-treatment\/","title":{"rendered":"The History of Pectus Excavatum Treatment"},"content":{"rendered":"

When Operating Was Almost as Dangerous as Not Operating<\/strong><\/h3>\n

In the first part of this series, we saw how pectus excavatum was documented for centuries \u2014 in the art of Da Vinci and Ribera, in 16th-century medical texts, in 19th-century family records \u2014 with no treatment available. Opening the chest was a death sentence: the lung would collapse once it lost the negative pressure of the pleural space.<\/p>\n

Read the following blog: The History of Pectus Excavatum<\/strong><\/a><\/p>\n

What followed was more than a century of progress, controversy, and reinvention \u2014 a continuous search for the same answer: how do you correct this deformity while causing the least possible harm?<\/p>\n

1913: Sauerbruch \u2014 The First Successful Correction<\/strong><\/h3>\n

Ernst Ferdinand Sauerbruch<\/strong> invented the negative-pressure chamber, the device that made it possible to operate inside the chest while keeping the lungs inflated. Without that invention, none of the surgeries that followed would have been possible.<\/p>\n

In 1913<\/strong>, Sauerbruch operated on a young man with severe pectus excavatum: breathless at rest, with constant heart palpitations, unable to work in his father’s watch factory. The procedure was radical \u2014 resection of the 5th through 9th left costal cartilages and an adjacent segment of the sternum \u2014 but the result was transformative. The patient regained his ability to work and got married three years later.<\/p>\n

What made Sauerbruch a true pioneer wasn’t just the technique. It was the vision<\/strong>: he was the first to clearly articulate that pectus excavatum wasn’t merely a cosmetic problem, but a deformity with real functional consequences that warranted surgical correction. That premise \u2014 which seems obvious today \u2014 took centuries to take hold.<\/p>\n

In the 1920s, Sauerbruch himself refined the technique by adding bilateral resection of the costal cartilages and a sternal osteotomy, and advocated for postoperative external traction to hold the sternum in its new position for six weeks. Surgeons across Europe and the United States adopted the procedure, and it quickly gained popularity.<\/p>\n

1939\u20131949: The Road to the Ravitch Standard<\/strong><\/h3>\n

During the 1930s and 1940s, several surgeons contributed modifications and observations to the original technique.<\/p>\n

In 1939<\/strong>, Ochsner and DeBakey<\/strong> published the most exhaustive review of the surgical literature on pectus excavatum to date, laying the groundwork for what was to come.<\/p>\n

That same year, Lincoln Brown<\/strong> published his experience with two patients and proposed that short diaphragmatic ligaments pulling the sternum downward were the main cause of the deformity. This theory would go on to decisively shape the technique Ravitch developed a few years later.<\/p>\n

Mark Ravitch<\/strong>, having read Brown’s article and convinced by the hypothesis, went further than any of his predecessors: in 1947<\/strong> he published his experience with a radical modification of Sauerbruch’s procedure that involved completely freeing the sternum from all its attachments \u2014 intercostal muscles, rectus abdominis, diaphragmatic insertions, and removal of the xiphoid process.<\/p>\n

The logic: if the sternum is completely freed from all tension, there’s nothing left to pull it inward. It shouldn’t sink again.<\/p>\n

In 1949<\/strong>, Ravitch published the formal case series that would cement his name in the history of surgery: his technique of bilateral resection of the deformed costal cartilages combined with a transverse wedge sternal osteotomy became the worldwide standard<\/strong>, dominating for the next four decades.<\/p>\n

The initial results were promising. Mortality and recurrence rates were significantly lower than with any previous technique. Ravitch became the benchmark.<\/p>\n

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Later Refinements<\/strong><\/h3>\n