Hinge reinforcement plate for adult pectus excavatum repair: a novel tool for the prevention of intercostal muscle strip☆

Adult pectus excavatum has been a challenge to repair by the conventional Nuss technique. The hinge point, the pivot for pectus bar rotation, is not strong enough to sustain the heavy adult chest. To prevent intercostal muscle strip at the hinge, we developed a hinge reinforcement plate. The hinge plate is a metal strip with a concave cradle designed to support the pectus bar at the hinge points (intercostal space entrance point). One hundred and two adolescent and adult patients (≥ 15 years old) who underwent pectus repair with our modified technique using pectus bars between April 2008 and March 2010 were analyzed. There were 27 patients repaired with the hinge plate (H group) and 75 patients without the hinge plate (N group). The mean age was 19.4 years (15-35 years). The degree of chest wall depression and asymmetry was not different between the groups (P > 0.05). There were three cases of bar displacement in the N group (4%), but no bar displacement (0%) in H group. Our results suggest that the hinge plate is effective in preventing an intercostal muscle strip at the hinge points and may play a crucial role in expanding the minimally-invasive technique to adult pectus excavatum.