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J Pediatr Surg. 2019 Nov 1. pii: S0022-3468(19)30672-4. doi: 10.1016/j.jpedsurg.2019.09.024. [Epub ahead of print]

Initial reduction of flexible pectus carinatum with outpatient manipulation as an adjunct to external compressive bracing: technique and early outcomes at 12 weeks.

Author information

1
Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK.
2
Department of Thoracic Surgery, St. George's Hospital, Tooting, London, UK; Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.. Electronic address: ajp.788@gmail.com.

Abstract

INTRODUCTION:

Our aim was to assess whether initial reduction with outpatient soft-tissue manipulation of flexible pectus carinatum deformity prior to external compressive bracing was associated with improved compliance and patient satisfaction compared to reported outcomes of external brace with progressive tightening.

MATERIALS AND METHODS:

From our observational cohort of 227 patients, 177 were felt appropriate to undergo initial reduction and soft tissue manipulation prior to immediate custom fitting of an external compressive brace. These patients then followed a prescriptive schedule of 12 weeks of continuous external bracing with subsequent follow-up in clinic.

RESULTS:

The reduction in Haller Index was maintained throughout the period of external bracing without the need for progressive tightening of the external brace. The treatment was associated with high levels of patient satisfaction and high patient concordance compared to other protocols. There were no major complications and minor complications included only skin irritation.

CONCLUSIONS:

Out-patient initial reduction with manipulation prior to external compressive bracing is a novel technique which resulted in excellent concordance and high rates of patient satisfaction and should be considered as an adjunct to standard external bracing techniques.

TYPE OF STUDY:

Treatment Study.

LEVEL OF EVIDENCE:

Level II.

KEYWORDS:

External compressive bracing (ECB); Haller index (HI); Manipulation; Pectus carinatum (PC)

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