Early experience in bracing for pectus carinatum deformity; a viable alternative to surgery
Advances in pectus carinatum (PC) management has been less practiced compared with excavatum (PE) which is considered far more common in the UK. As the treatment of pectus deformity is being scrutinised, innovation in this field is required. We identified that the rate of PC in Wales is more common than perceived. Additionally, bracing is a recognised alternative management to surgery in PC. Therefore, we have initiated bracing program for suitable PC patients.
We reviewed the referral rates of PC vs. PE. We offered bracing to younger patients who have compliant PC deformity using the dynamic compression system FMF®. We measured the pressure applied by the brace, the reduction in the maximum anterioposterior distance (AP) between the spine and prominent sternum. We recorded the patient compliance and incidents of complications.
The rates of PC vs PE in Wales (53 vs. 83) seems more common than most reports suggesting PC no more than 10-20% of pectus deformities. We identified 19 PC patients to be suitable for bracing treatment. In 13 patients bracing was felt to be a better choice over surgery due to chest wall compliance, age, growth pattern, Patient’s dedication and choice. Of those, 6 patients were fitted with the brace and all were males. All patients had reduction in AP up to the time this report between 1 and 2.5cm (Table). 5 patients continued to wear the brace and have been compliant with very little side effects (Picture). One patient stop wearing it due pressure on the skin and pain (patient 1). Satisfactory results were achieved in two patients within 2 months (patients 4 and 6) and now on maintenance period. The other 3 compliant patients are satisfied with the outcome so far.
Dynamic bracing could offer an effective less invasive alternative to surgery for PC. Young patients with compliant chest and particularly motivated are ideal candidates. Additionally, bracing could offer a cost-effective way to treat pectus in the current difficult economical climate.