Staged management of pectus carinatum



      The aim was to report the treatment of pectus carinatum with a novel Argentine brace and operation.


      The bracing and clinical data of 137 consenting pectus carinatum patients treated between October 2008 and December 2011 were reviewed for outcome. Institutional approval was obtained. Data are reported as median (range).


      Median age 122 bracing patients was 14 (10–28)years with 67 (55%) progressing under active treatment. Five patients (4%) were lost to follow-up, and thirteen (11%) failed treatment. Thirty-seven patients (30%) exhibited flattening of the sternum after 6 (1–24)months without surgery. After flattening, patients then wore the brace for progressively fewer hours each day as a “retainer” for 5 (3–19)months. Five patients (4%) experienced recurrence 5 (3–7)months after brace treatment was discontinued. Complications were limited to transient skin breakdown in nine patients. Three of the 13 Argentine brace failures and 15 other pectus carinatum patients were treated surgically. Thirteen underwent Abramson's minimally invasive operation and five an open repair, all with good initial correction. For Abramson repairs, seven patients have had bars removed, with results rated as excellent (n=4), good (n=2), and failure (n=1, converted to open with excellent result later). In three patients with stiff chests, costal cartilage was resected thoracoscopically during the Abramson repair with measurably improving compliance.


      Staged treatment of pectus carinatum allows most teenagers to be managed non-operatively. For patients who fail bracing or are not amenable to bracing, minimally invasive surgical treatment for pectus carinatum is a viable option.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abramson H.
        A minimally invasive technique to repair pectus carinatum.
        Arch Bronconeumol. 2005; 41: 349-351
        • Frey A.S.
        • Garcia V.F.
        • Brown R.L.
        • et al.
        Nonoperative management of pectus carinatum.
        J Pediatr Surg. 2006; 41: 40-45
        • Egan J.C.
        • Du Bois J.
        • Morphy M.
        • et al.
        Compressive orthotic bracing in the treatment of pectus carinatum: the use of radiographic markers to predict success.
        J Pediatr Surg. 2008; 43: 1776-1780
        • Kravarusic D.
        • Dicken B.J.
        • Dewar R.
        • et al.
        The Calgary protocol for bracing pectus carinatum: a preliminary report.
        J Pediatr Surg. 2006; 41: 923-926
        • Lee S.Y.
        • Lee S.J.
        • Jeon C.W.
        • et al.
        Effect of the compressive brace in pectus carinatum.
        Eur J Cardiothorac Surg. 2008; 34 ([Epub 2008 May 13]): 149-159
        • Haje S.A.
        • Raymundo J.L.P.
        Consideraçõessobredeformidades da paredetorácica anterior e apresentação de tratamentoconservadorpara as formas com componentes de protrusão.
        Rev Bras Ortop. 1979; 14: 167-178
        • Haje S.A.
        • Bowen J.R.
        Preliminary results of orthotic treatment of pectus deformities in children and adolescents.
        J Pediatr Orthopaed. 1992; 12: 795
        • Martinez-Ferro M.
        • Fraire C.
        • Bernard S.
        Dynamic compression system for the correction of pectus carinatum.
        Semin Pediatr Surg. 2008; 17: 194-200
        • Abramson H.
        • D'Agostino J.
        • Wuscovi S.
        A 5-year experience with a minimally invasive technique for pectus carinatum repair.
        J Pediatr Surg. 2009; 44: 118-124
        • Schaarschmidt K.
        • Lempe-Sellin M.
        • Schlesinger F.
        • et al.
        New Berlin–Buch “Reversed Nuss”, endoscopic pectus carinatum repair using eight-hole stabilizers, submuscular CO2 and presternal Nuss bar compression: first results in 35 patients.
        J Laparoendosc Adv Surg Tech. 2011; 21: 283-286
        • Kalman A.
        Initial results with minimally invasive repair of pectus carinatum.
        J Thorac Cardiovasc Surg. 2009; 138: 434-438
        • Varela P.
        • Torre M.
        Thoracoscopic cartilage resection with partial perichondrium preservation in unilateral pectus carinatum: preliminary results.
        J Pediatr Surg. 2011; 46: 263-266
        • Groves S.
        • Roberts C.
        • Johnstone C.
        • et al.
        A high status burial from Ripon Cathedral, North Yorkshire England: differential diagnosis of a chest deformity.
        Inter J Oseoarchaeology. 2003; 13: 358-368