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Author: Subject: New Improved implant for Pectus Excavatum
BullyBulldog
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[*] posted on 5-10-2008 at 12:33 AM
New Improved implant for Pectus Excavatum


A new endoscopic treatment for cosmetic repair of Pectus Excavatum using a Porous Polyethylene Implant has been developed and so far the results have been excellent. This implant has usually used as brain casing in surgery but has had incredible results on PE patients. The bespoke hollow implant is filled with the hosts gastro tissue which intergrates fully with the host and with 8 months feels exactly like a sternum should.

Before a flurry of forum posters reply with the usual 'implant bashing' that tends to follow saying this does not fix, only hide the PE then please save your energy from typing that as WE ALL KNOW THAT. Implant surgery is only an option for people with mild/moderate PE who have no cardiopulmonary issues which is believed to be around 95% of the PE population.

Implant surgery for PE is known as a camouflage surgery and most PE sufferers only require a camouflage surgery as most PE sufferers have only a mild moderate form of the condition that will cause no cardiopulmonary problems. So camouflage surgery for this condition is very much an option for most PE sufferers. I think most users of this site are anti-implant because they think it doesn't fix the problem, they are quite right, it doesn't but for many/most of PE sufferers their condition is cosmetic and it causes no ill health effects so this post is for those people.

Let me tell you a liittle more about this new exciting procedure. It has been developed and used in Italy since 2001 and has been used on patients presented with no previous surgeries and those presented with failed previous surgeries including nuss,ravitchand older style silicone implant surgeies. I have stumbled across this procedure in my search to find the perfect camouflage technique and so far this has excited me the most, even more so than Bio-Alcamid.

they use a premade prosthesis of Porex,
originally designed for bone reconstruction of the temporal
region. Porex is a high-density linear polyethylene material
for surgical implants. It has a porous structure equal to 50%
porosity, with pores larger than 100 lm in diameter.
The prosthesis is compact, resistant, and light. At the same
time, it is flexible and easy to model and manipulate.
Its incision does not compromise the solidity of the
implant. It allows good tissue integration thanks to the
growth of autologous tissue into the internal porous
structure, guaranteeing stability and solidity of the implant over time.
Surgical Technique
The surgical intervention is performed with the patient
under general anesthesia and lying supine with arms at 90
and lower limbs splayed to allow positioning of the surgeon
during the endoscopic phase.
Phase 1
A 4.5-cm reverse V-shaped cutaneous incision is made in
correspondence to the xiphoid process, and a pocket is
made to contain the prosthesis by detachment of the presternal
teguments via subpericondral of the malformed area.
The pectoral muscles are partially disconnected from their
rib insertions.
Phase 2
Pneumoperitoneum is performed with a 10-mm Hasson
trocar through the umbilicus. After exploration of the
abdominal cavity, one 5-mm trocar per iliac fossa is
positioned, and a flap of omentum, pedunculated on the left
gastroepiploic vessels, is prepared. The flap then is mobilized
and superficialized over the sternal plate through a 2-
cm incision along the median line between the rectus
muscles immediately below the xiphoid process.
Phase 3
The flap of the omentum is positioned in the presternal
pocket created previously and held with absorbable sutures
in such a way as to cover the area involved (Fig. 1). At the
same time, a physiologic solution is heated to about 60C.
The Porex prosthesis is submerged in the heated solution,
making it flexible and malleable. Next, it is is cut and modulated
into shape and thickness to obtain the most precisecorrection of the defect possible. The prosthesis then is
inserted through the sternal incision and placed above the
omentum in the created pocket. When possible, the pectoral
muscles are medialized and sutured together to provide a
thick covering of the prosthesis, achieving a harmonized
result. If the deficit is so wide that the free insertions of the
pectoral muscles cannot join, they are sutured above the
implant with Vicryl 2-0 at one or two points.

Results
The overall duration of the surgery varied from a minimum
of 94 min to a maximum of 182 min (mean value, 137.2
min). The average hospital stay was 3.6 days (range, 26days). During the follow-up period, 10 of the 11 patients
who underwent the surgery were examined for a minimum
of 9.2 months and a maximum of 28.1 months (average
follow-up period, 16.3 months) (Figs. 24).
No postoperative complications were reported for the
examined cases. Neither premature complications (seroma,
hematoma, infections, or complications tied to the laparoscopy
procedure) nor late complications (dislocation or
distortion of the prosthesis, lack of tissue integration,
hypertrophy of the scars) occurred.
The aesthetic parameters considered, other than the
global correction of the defect, were symmetry and position
of the prosthesis, absence of evident margins, and quality
of the scars. From the functional point of view, we considered
the solidity of the implant and its integration withthe adjacent muscular and skeletal structures. In our
opinion, the results were very satisfying both aesthetically
and functionally.
All patients examined expressed extreme satisfaction
with the obtained results.

The psychological implications of a pectus excavatum
represent the most frequent indication for surgery,
considering that 95% of adult cases are without cardiopulmonary symptoms.

I cannot upload pictures of this procedure for some unknown reason but I am happy to email to anybody who PM's me, the results are outstanding with little scarring.

And please remember this post is for PE sufferers who don't need the BIG fix, so don't go bashing it as we all have different needs for our condition so please respect that.
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[*] posted on 5-11-2008 at 07:24 AM


Very interesting. Thanks for sharing this. Where did you find out about this new implant? What is it called and does it have a website?
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[*] posted on 5-11-2008 at 06:18 PM


My only concern with an implant is will it stay in place?
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[*] posted on 5-12-2008 at 01:16 AM


My only concern with an implant is will it stay in place?

It is fully stable, they place partly under the pectoral muscles which partially sit on top of the implant then a fair amount of your own gastro fatty tissue is inserted within the implant which again offers stability, they have performed many more surgeries since the paper was submitted with NO problems of dislodgement. The surgeon is confident that this is the best cosmetic surgery for PE thats ever been available and I'm with him the pictures speak for themselves.

I find it very difficult to upload pictures on this site!! i will by hook or by crook try and get some images uploaded today!

Sorry there is not a website available as it's a medical paper so I can't upload a link.


I have spoken to the surgeon and he gave some more info below (excuse broken english)

What we do is an innovative camouflage intervention in order to elimiate the defects. Basically our technique is innovetive for 2 reasons:

1- Material type: originally used for cranial recontructions, such prothesys is able to be completely integrated with sourraounding tissues and personally-modelled directly in the operation theater. In 8 month after intervention will feel like sternal bone.

2- We endoscopically raise a flap of omentun (vascolarized fat tissue in the abdominal cavity) which is set into the cavity of the prothesys in oder to let the prothesys to be finally integrated (hope to be clear..).

We had experience of silicon prothesys for PE as long as several patients came from as for removing such prothesys and correct the problem afterward with ours technique.
I really can't suggest to use sintetic semi-liquid material as Bio-Alcamid: we don't use it at all as we often see a very very hi rate of serious complications.

In Conlusions, we are happy about obtained results.

I will as said previously try and get the pictures up today, i will email to anyone who requested via PM.
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[*] posted on 5-12-2008 at 01:32 AM
Images


Right here we go, hopefully this will work:

http://i286.photobucket.com/albums/ll102/bullybulldog_2008/p...
(A) Intraoperative view showing the umbilical endoscopic access and the sternal incision with the raised omentum flap. (B) Lifted omentum flap through sternal incision before prosthesis implantation. (C) View of Porex prosthesis before subcutaneous implantation over the omentum flap


http://i286.photobucket.com/albums/ll102/bullybulldog_2008/p...
Preoperative left oblique view (A) and postoperative result (B) in the case of a 22-year-old patient after a follow-up period of 7 months

http://i286.photobucket.com/albums/ll102/bullybulldog_2008/p...
A) Preoperative frontal view of a 27-year-old patient showing an asymmetric defect. (C) Right oblique view of the same patient. Postoperative in frontal (B) and oblique (D) views after follow-up period of almost 1 year


http://i286.photobucket.com/albums/ll102/bullybulldog_2008/p...
(A,C) Frontal and oblique preoperative views. The first patient treated was a 41-year-old man with a funnel chest. (B,D) Postoperative views of same patient after a follow-up period of 28 months
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[*] posted on 5-20-2008 at 12:19 AM


How much does this procedure cost?
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[*] posted on 5-20-2008 at 02:49 AM


I am actually in the process of working out the total costs at the moment including procedure, surgeon fees, theatre costs, hospital stay, hotel stay & flights from UK. I will advise asap with full break down.
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[*] posted on 5-22-2008 at 11:14 PM


are you telling me that i have to travel to the uk to get this procedure done?
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[*] posted on 5-23-2008 at 01:49 AM


Currently this procedure is only available in Italy, I intend to travel there from the UK to have it done depending on the overall price of course. There is a possibility to train this procedure to overseas surgeons as it has been so successful in Italy and they believe it will see the end of silicone implants for PE eventually.
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[*] posted on 5-23-2008 at 05:18 PM


Just be careful. If someone publishes a paper they may leave out the bad results!



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[*] posted on 5-23-2008 at 11:02 PM


Don't worry young man, I will leave no stone unturned trust me I'm known for that!!
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[*] posted on 5-24-2008 at 03:34 AM


Im sure you have done some good detective work ;) But on what exactly have you based your decision?
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[*] posted on 5-24-2008 at 06:51 AM


I doubt the NHS in england would do that procedure not until a good few years even if its that good of a procedure. In 1 way i dont think i would want to travel to italy to get a implant just incase something does go wrong because you wont be to keep traveling back there.
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[*] posted on 5-24-2008 at 11:32 PM


Excellent detective work Bulldog. Keep us posted. If the cost is reasonable, definitely an option to look into.

Any mention of recovery time as far as working out in the gym?
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[*] posted on 5-25-2008 at 06:43 AM


do you think this is a better alternative to Bio-alcamid?


as far as i know, bio-alcamid seems pretty nice since its done by injections.
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[*] posted on 5-25-2008 at 08:12 AM


well i agree Bio-Alcamid sounds amazing and there are a number of people who seem to be very happy with the results, however a few things concern me:
1: the fact that it has not been proven long term with regards to safety. i.e migration etc as it is a liquid.
2: the fact that it feels soft which is the opposite to how a sternum should feel.
3: the fact that those who have had the procedure never seem to post any decent pictures of their results which really annoys me as they always say they will.
4: the cost, very expensive indeed.

On the other hand it seems the less invasive, painful & quikest recover of all pectus camoflage techniques. I wish those who have had it done or surgeons such as David Ross in London would post some images of before and after so we can see for ourselves. Most pics available are by the products developer and they won't show any dodgy pics as they have a financall interest to protect.
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[*] posted on 5-25-2008 at 10:03 AM


Yeah its really annoying that nobody who has had the bio-alcamid treatment post any pictures :(
I have created a post/resource for implants but i have had very little success so far. see -> http://www.pectusinfo.com/board/viewthread.php?tid=5038
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[*] posted on 5-25-2008 at 10:05 AM


BullyBulldog: Has the surgeons sent you any additional pictures to the ones in the paper?
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[*] posted on 5-25-2008 at 10:21 AM


he can't email them because he doen't have patient permission but can show me hoprfully when we meet. He said they have performed many more since the paper was published and still have had NO problems and all patients extremely satisfied with results.
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[*] posted on 5-26-2008 at 08:40 AM


just had an email from the surgeon who said the cost of surgery will be between 13,000 - 15,000 EUROS. That's is unreasonably high in my opinion, over three times the cost of silicone implant or bio-alcamid. Me thinks a bit too expensive for me! time to re-think my plans/options.:puzz:
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[*] posted on 5-26-2008 at 10:25 AM


Blimey! :sh:
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[*] posted on 5-26-2008 at 11:10 AM


blimey exactly, apparently its the laparoscopic phase of the procedure that drives the price through the roof. Better start doing the lottery again i think!!
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[*] posted on 5-26-2008 at 11:59 AM


Damn thats a lot. I hope you will be able to get funding from the NHS. If you are 100% sure that this is the procedure you want, go for it now as 15000 probably the cheapest this procedure will ever be as its reletively new. Take Schaar, for example, he was charging 14000 a couple of years ago. NOw its 18000 i think.
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[*] posted on 5-26-2008 at 11:55 PM


I can assure you the NHS will not fund this, NOT A CHANCE. They have really cut back over recent years!!
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[*] posted on 5-29-2008 at 01:09 PM


Bad news Bulldog, for that price I'd just do the Nuss with Schaar.
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