Special techniques in the funnel chest deformity

With the triumphal march of the surgical method (MIRPE) in the correction of pectus excavatum deformities, according to Donald Nuss [6] the method originally described by Ravitch in 1949 and 1958 [9, 10] was partially dislodged into the background and minor scope was left for special applications only. However the Ravitch technique is still widely used as a standard procedure in the correction of pectus carinatum deformities (Chapter 7.1) Although a recent study consisting of a systematic review and meta-analysis methodology confirmed that the complication rate in the MIRPE technique is higher than in the Ravitch technique, and the period of requirement of postoperative analgesics seems to be lower than in the MIRPE collectives, a clear difference concerning the aesthetic outcome could not be elaborated. It seems that particularly the parameters of pain and aesthetic result, being of paramount importance for the patient self, could not be studied comparatively due to too many biasing factors and lack of long-term comparability [1, 5]. Despite that the MIRPE technique offers a method requiring far shorter surgery time and represents an overall elegant method with however pleasing results lasting for many years. The elegancy and straightforward technique in experienced hands with relatively hidden scars supported its triumphal march so far, convincing patients and surgeons as well. However, these findings are predominantly true for children and adolescents, but must be regarded differentiated in adults. For the latter collective of patients no comparative data are yet available.