Find best premium and Free Joomla templates at GetJoomlaTemplatesFree.com

Pectus Press in the Nuss Procedure (PP) - A Pilot Study

Jose Ribas Milanez de Campos, Maria Candida de Miranda Luzo

San Paulo, Brazil

 

Objective: Evaluation of effectiveness of the use of the Pectus Press (PP) on patients with Pectus Excavatum (PE) as initial and post-operative of the Nuss procedure for the correction of posture, reduction of pain and prevention of bar displacement.

Methods: Between August 2015 and January 2016, a total of 48 patients (children and adults) with PE were treated with PP in the Division of Thoracic Surgery and Occupational Therapy (University of São Paulo, Brazil). On first visit patients received the orthotic equipment and were oriented to follow a home exercise program and physical activities. Nineteen (39.5%) patients underwent surgery with the Nuss procedure during this period of time. The main characteristics of the PP are: correction and preservation of posture avoiding thoracic kyphosis, associated shoulder anteversion and light circular compression and extra pressure over the prominent costal flaring. All patients easily adapted to this single piece with axillary padding and also the back rest rigid plastic. All parts have cushioned supports. We also checked the correct size, position of the thoracic supports and the pressure of the shoulder straps on each visit every 30-60 days. Valsalva manouver and a program of exercises to increase thoracic flexibility.

Results: Better posture and more flexibility of the thorax were observed by patients and parents after the first three weeks including reduction of costal flaring in 39 (81.2%) that used the device for more than 12 hours a day including nightime use. In the first 30-60 days of post-operative period, it also helped to reduce the pain and the possibility of bar bending, with the maintenance of a better corrected posture of patients. No bar displacement was observed in the operated group and less pain medication was prescribed after discharge from hospital.

Conclusions: Treatment using orthosis for PE has been very well described (Haje Method).  Pectus Press is a flexible low profile orthosis, a promising alternative and has shown to be a useful tool in the pre- and post-operative periods of the Nuss procedure. It provides thoracic chest wall flexibility, less pain and no bar displacement in this pilot study with a short period of time. The success of treatment was directly linked to the patient age, time and frequency of use of the device.

Keywords: Conservative treatment, pectus excavatum, orthotic treatment, Nuss procedure, brace therapy