Dynamic compression bracing for pectus carinatum

Canada’s Milos Raonic, of Toronto, traps a soccer ball with his chest while playing with teammate Vasek Pospisil and coaches after the Davis Cup tennis practice in Vancouver, British Columbia, Wednesday, March 4, 2015. AP Photo, The Canadian Press, Darryl Dyck

BACKGROUND
Dynamic brace compression is a novel treatment for patients with pectus carinatum. The dynamic compression system contains a device to measure the flexibility of the thoracic wall and regulate the pressure of the brace.
METHODS
Patients referred to our pediatric surgical center were screened for treatment with the dynamic compression brace. Patients with a pressure of initial correction (PIC) of 10.0 pounds per square inch or less were offered treatment with the brace. Patients with a PIC above 10.0 pounds per square inch were offered surgical correction.

Between March 2013 and April 2016, 286 patients were treated with the brace; 260 were male (91%) and 26 were female (9%). Their mean age was 14 years (range, 4 to 21 years).

RESULTS
Seventy-eight patients completed brace treatment; the mean treatment time was 14 months. Twenty-seven patients abandoned treatment because of lack of motivation, loss to follow-up, persistent protrusion of the sternal bone or flaring that required surgical correction, failure of treatment because of a bifid rib, fear of locking the brace, and delayed correction.

One hundred eighty-one patients are still wearing the brace, either in the active or in the retainer phase. Patients with a high PIC also showed improvement when they were compliant. Adverse events were minor and included skin lesions (n = 4, 1%) and vasovagal reactions at the start of therapy (n = 3, 1%).

CONCLUSIONS
These data show that brace therapy can be considered a valuable treatment option to correct pectus carinatum in patients with a flexible thorax.

The Dynamic Compression Brace for Pectus Carinatum: Intermediate Results in 286 Patients, de Beer SA, Gritter M, de Jong JR, van Heurn ELW. Ann Thorac Surg. 2017 Jun;103(6):1742-1749. doi: 10.1016/j.athoracsur.2016.12.019. Epub 2017 Mar 6.

Also see
Highly Efficient Conservative Treatment of Pectus Carinatum in Compliant Patients, Loff S, Sauter H, Wirth T, Otte R. Eur J Pediatr Surg. 2015 Oct;25(5):421-4. doi: 10.1055/s-0034-1384648. Epub 2014 Aug 11.
Factors affecting patient compliance with compressive brace therapy for pectus carinatum, Kang DY, Jung J, Chung S, Cho J, Lee S. Interact Cardiovasc Thorac Surg. 2014 Dec;19(6):900-3. doi: 10.1093/icvts/ivu280. Epub 2014 Aug 27.

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