Silastic Molding Method for Pectus Excavatum Correction Using a Polyvinyl Alcohol (Ivalon) Sponge
A 15-year-old male had visited our outpatient clinic of Hanyang University Seoul Hospital due to pectus excavatum in 2007. He had no symptoms such as chest pain, dyspnea, or heart problems. However, he complained of cosmetic problems due to the appearance of his asymmetrical chest wall.\nEchocardiography was performed to check for possible heart problems, and the results were normal. A pulmonary function test was performed to check for any lung problems, and the results presented a force vital capacity (FVC) of 4.06 L and a forced expired volume in 1 second (FEV1) of 3.68 L, showing a normal pattern of flow-volume. However, the patient wanted to undergo surgery to obtain a more symmetric chest wall. We recommended a follow-up visit because he was in rapid adolescent growth. Therefore, surgical treatment was delayed until his chest wall was fully developed.\nIn 2010, when he was 18 years old, he still wanted the operation for his pectus deformity. At that age, we assumed that he achieved full skeletal maturity. Therefore, we decided to perform surgical treatment for the pectus excavatum. Echocardiography and pulmonary function tests were performed. The results of the echocardiogram were an ejection fraction of 57%, normal valve function, normal wall motion, and no pericardial effusion. In addition, the results of the pulmonary function test were an FVC of 4.1 L and an FEV1 of 3.8 L; they were within normal range. A follow-up chest computed tomography showed no interval change of the pectus excavatum (). The laboratory findings showed a white blood cell count of 5,800/mm3, hemoglobin at 15.1 g/dL, platelet count of 218,000/mm3, bleeding time at 3 minutes, and prothrombin time of 10.9 seconds. The liver enzymes aspartate aminotransferase and alanine aminotransferase were 16 U/L and 11 U/L, respectively, and the levels of sodium, potassium, and chloride electrolytes were normal. All of the laboratory findings were within normal limits except the bilirubin level. The total bilirubin and direct bilirubin were elevated to 2.2 mg/dL and 0.9 mg/dL, respectively. Thus, abdominal ultrasonography and a consultation with the department of gastrointestinal medicine were performed. The abdominal ultrasonography showed normal findings except for dilatation of the common bile duct, and Gilbert's syndrome was suspected based on the results from the consultation with the Department of Gastrointestinal Medicine. The operation was proceeded as planned ().\nUnder general anesthesia, the patient was placed in the supine position. Right periareolar incision was performed. Subcutaneous dissection was performed to reach to the concave area of the pectus excavatum. The space of that area was filled with a polyvinyl alcohol sponge soaked in antibiotics mixed with warm saline. The patient was discharged on postoperative day 8 ().