69 (877) pigeon chest, modified Ravitch operation, chest plastic surgery Robicsek classification

69 (877) pigeon chest, modified Ravitch operation, chest plastic surgery Robicsek classification

70 (878) Fig. 1 A and B, preoperative (correction) finding of anterior chest surface with an asymmetrical pigeon chest. Fig. 3 Chest CT scan shows defomities and protrusion of the costal cartilages ( marked), twist of the sternum. A B Fig. 2 Chest X-ray film on admission. A : front view, B : showing forward projection of the sternum in lateral view.

71 (879) A B Fig. 4 A. Scheme of this operation method. B. View in operation just after correction. C. State after operation. C

72 (880) A B Fig. 5 A and B, both photographs show the state after operation (correction), at discharge.

73 (881) 14) Aston SJ, Pickrell KL : Chest wall reconstruction. Reconstructive Plastic Surgery 2 nd edit, Edited by JM Converse, vol 7 : 3646-3652, WB Saunders Co, Philadelphia, 1977. 15) Francis Robicsek, Joseph W Cook, Harry K Daugherty, et al : Pectus carinatum. J Thorac Cardiovasc Surg 78 : 52-61, 1979. 16) Francis Robicsek, Harry K Daugherty, Donald C Mullen, et al : Technical Considerations in the Surgical Management of Pectus Excavatum and Cari-natum. Ann Thorac Surg 18 : 549-564, 1974. 17) Ravitch MM : Disorders of the sternum and the thoracic wall. Gibbon's Surgery of the Chest 4 th edition : 318-342, WB Saunders Co, Philadelphia, 1983. 18) Ravitch MM : Congenital Deformities of the Chest Wall and their Operative Correction, 206-232, WB Saunders Co, Philadelphia, 1977. 19) Ravitch MM : The operative correction of pectus carinatum (pigeon chest). Ann of Surg 151 : 705, 1960.

74 (882) Reduction of the thorax in a patient with pigeon chest by a modified Ravitch procedure Yuuichi Hashimoto, Shigeki Sugiyama*, Yoshinori Doki Kazuhiro Mino, Motoharu Tsuda, Takuro Misaki 1 st Department of Surgery, Toyama Medical & Pharmaceutical University, Faculty of Medicine, Toyama Department of Respiration, Tomei-Atsugi Hospital A 17-year-old patient with an asymmetric pigeon chest (Robicsek type III), favorably reduced by a modified Ravitch operation, is reported. Among thoracic deformities, the incidence of funnel chest is higher than that of pigeon chest. Various operations such as a sternal turnover, sternal elevation, and Ravitch operation have been performed for funnel chest. These operation methods have been improved in various ways, but there seems to be no standard operation method for pigeon chest, since its frequency is lower. Pigeon chest usually causes fewer clinical problems, because the deformity protrudes forward. In the present study, we employed a modified Ravitch operation in which a wedge was added by osteotomy to the dorsal surface of the sternum body. This surgery relieved the torsion at the sternum and also enabled us to reduce the asymmetric pigeon chest relatively easily without being concerned about the hardness of the bony chest wall. As a result, this surgical procedure was useful for asymmetric pigeon chest (Robicsek type III). Five years and ten months following the operation, the subject has not suffered any recurrence of distortion.