• Felix Schier, Michael Bahr, and Eckard Klobe.
• Department of Pediatric Surgery, University Medical Centre, 55101 Mainz, Germany. schier@kinderchir.klinik.uni-mainz.de
• J. Pediatr. Surg. 2005 Mar 1; 40 (3): 496-500.

PurposeThis report describes the authors' experience using a vacuum to pull the abnormal chest wall outward in patients with pectus excavatum.MethodsA suction cup was used to create a vacuum at the chest wall. A patient-activated hand pump was used to reduce pressure up to 15% below atmospheric pressure. The device was used by 60 patients (56 males, 4 females), aged 6.1 to 34.9 years (median, 14.8 years), for a minimum of 30 minutes, twice a day, up to 5 hours per day (median, 90 minutes). Patient progress was documented using photography, radiography, and plaster casts of the defect. In 14 children this method was used during the Nuss procedure to enlarge the retrosternal space for safer passage of the introducer.ResultsFollow-up occurred between 2 and 18 months (median, 10 months). Computed tomographic scans showed that the device lifted the sternum and ribs within 1 to 2 minutes; this was confirmed thoracoscopically during the Nuss procedure. The suction cup enlarged the retrosternal space for safer passage of the introducer. Initially, the sternum sank back after few minutes. After 1 month, an elevation of 1 cm was noted in 85% of the patients. After 5 months, the sternum was lifted to a normal level in 12 patients (20%) when evaluated immediately after using the suction cup. All patients exhibited moderate subcutaneous hematoma, although the skin was not injured. One patient suffered from transient paresthesis in the right arm and leg. Two patients experienced orthostatic disturbances during the first application of the suction cup. There were no other complications.DiscussionIn patients with pectus excavatum, application of a vacuum effectively pulled the depressed anterior chest wall forward. The initial results proved dramatic, although it is not yet known how much time is required for long-term correction.ConclusionsThis vacuum method holds promise as a valuable adjunct treatment in both surgical and nonsurgical correction of pectus excavatum.

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