Managing Pectus Excavatum After Surgery: Rehabilitation or Revision?

Sternal deviation

Hello Doctor: My husband underwent a sternum flip surgery at the end of October last year, but the section of the sternum that was cut did not heal properly.
Can rehabilitation help alleviate his symptoms? The risk of undergoing another surgery is extremely high.

1.
The lowering of the ribs on both sides and the sinking of the sternum have reduced the space in the thoracic cavity.
The air inhaled is quickly expelled, leading to shortness of breath and dizziness.
The sternum pressing against the heart causes severe chest tightness, significant discomfort in the heart, and a feeling of suffocation, which can drive a person to the brink of suicide.

2.
The pressure on the heart has resulted in severe insomnia.
There is poor circulation throughout the body, leading to systemic hypoxia and weakness, along with chronic nasal congestion.

3.
The body feels very hot yet is sensitive to cold.
The chest experiences numbness that extends throughout the body.

4.
Due to the bones not being properly aligned and lacking support, there is weakness in the arms.
Holding the arms up feels strenuous, and there is a heavy sensation in the head, making it difficult to sit or stand for extended periods.

Shirley, 30~39 year old female. Ask Date: 2008/03/19

Dr. Ke Fangxu reply Surgery

Dear Ms.
Tai Ping Lai,
Is your husband undergoing surgery for pectus excavatum (sunken chest) or pectus carinatum (pigeon chest)? Typically, chest surgeries are categorized into these two types, with pectus excavatum surgery being more common.
Adults usually seek this surgery due to aesthetic or functional concerns.
If there were respiratory issues prior to surgery, a recovery period will be necessary post-operation.
After pectus excavatum surgery, the thoracic cavity volume increases, which generally alleviates respiratory problems; conversely, pectus carinatum surgery may require a longer adaptation period.
If the issues are merely related to adaptation, respiratory rehabilitation can indeed help improve the situation.

However, without knowing what you mean by "not aligned" or the depth of the depression, it is difficult to determine whether these symptoms are related to the surgery itself.
Nasal congestion, heat intolerance, and difficulty standing or sitting for long periods are likely unrelated to the surgery; chest tightness may be an adaptation issue post-surgery; and weakness in the arms can result from the detachment of the pectoralis major during the procedure, which can be improved through rehabilitation.

If the pectus excavatum is severe, a revision surgery may be necessary to resolve the issue.
Generally speaking, chest surgeries are not considered highly dangerous, as they do not involve the lung parenchyma or heart during the procedure.
Aside from pain and the need for respiratory rehabilitation, the primary risk is the potential for wound infection.

I would recommend that your husband undergo a period of rehabilitation first.
If his symptoms do not improve, a thorough evaluation of the possibility of revision surgery may be warranted.

Wishing your husband a speedy recovery.
Best regards,
Ke Fangxu

Reply Date: 2008/03/19

More Info

Managing Pectus Excavatum after surgery, particularly after a sternum flip procedure, can be quite challenging, especially when complications arise such as improper alignment of the sternum. Your husband's situation, where the sternum has not healed correctly, can lead to a variety of symptoms that significantly impact his quality of life.
Firstly, it is essential to understand that Pectus Excavatum, a condition characterized by a sunken chest, can cause various physical and psychological issues. After surgical intervention, if the sternum does not align properly, it can lead to compression of the heart and lungs, resulting in symptoms such as shortness of breath, chest pain, and even psychological distress due to the physical discomfort and the impact on self-image.

1. Rehabilitation vs. Revision Surgery: Rehabilitation can be beneficial in managing symptoms, but it may not correct the underlying structural issues. Physical therapy can help strengthen the muscles around the chest and improve respiratory function, which may alleviate some symptoms. However, if the sternum is significantly misaligned and causing severe symptoms, revision surgery may be necessary despite the risks involved. It is crucial to weigh the potential benefits of surgery against the risks, especially considering your husband's current health status and the severity of his symptoms.

2. Symptoms Management: The symptoms you describe, such as difficulty breathing, chest tightness, and feelings of suffocation, are concerning. These symptoms suggest that the heart and lungs may be under significant strain due to the structural issues. It is vital to consult with a cardiothoracic surgeon who specializes in Pectus Excavatum to evaluate the situation comprehensively. They may recommend imaging studies, such as a CT scan, to assess the alignment of the sternum and its impact on the heart and lungs.

3. Psychological Impact: The psychological effects of living with Pectus Excavatum and its complications can be profound. Feelings of despair, anxiety, and thoughts of self-harm are serious and should be addressed. It may be beneficial for your husband to speak with a mental health professional who can provide support and coping strategies.

4. Long-term Management: If surgery is deemed too risky at this time, a multidisciplinary approach involving physical therapy, respiratory therapy, and psychological support may be the best course of action. Regular follow-ups with healthcare providers are essential to monitor his condition and adjust treatment plans as necessary.

5. Lifestyle Modifications: Encouraging your husband to engage in light physical activity, as tolerated, can help improve circulation and respiratory function. However, he should avoid any activities that exacerbate his symptoms. Additionally, ensuring a healthy diet and managing stress through relaxation techniques can contribute to overall well-being.

In conclusion, while rehabilitation may provide some relief, it is crucial to have a thorough evaluation by a specialist to determine the best course of action. If symptoms persist or worsen, revisiting the option of revision surgery may be necessary. Your husband's health and quality of life are paramount, and addressing both the physical and psychological aspects of his condition will be essential in managing his recovery.

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