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Partial Sternotomy In Young Infants And Children: Mid-term Incidence Of Sternal Deformity And Hypertrophic Scar Changes
Heeju Hong;
Seoul national university hospital, Jongno-gu, Seoul, Korea, Republic of
BACKGROUND: There are limited minimally invasive cardiac surgery (MICS) options for pediatric patients because the currently available surgical instruments are too large; therefore, partial sternotomy is usually the sole choice. Chest wall deformity and hypertrophic scar changes are also concerns in pediatric patients because of future growth.
METHODS: Between 2016 and 2021, 107 patients who underwent partial sternotomy and were followed up for at least 6 months postoperative were retrospectively reviewed. MICS is usually applied in relatively simple diseases that require shorter surgical time, such as isolated atrial or ventricular septal defects. A single surgeon scored the degree of sternal deformity and hypertrophic scar. We then analyzed the incidence of sternal deformity and hypertrophic scar changes as well as the factors affecting them.
RESULTS: No cases of operative mortality or morbidity were observed. Among the 107 patients, 86 (80.4%) had no sternal deformities. Eleven patients (10.2%) showed pectus excavatum, while 10 (9.3%) showed pectus carinatum features. One patient (0.9%) underwent Nuss bar insertion to treat the pectus excavatum. No identified factors affected sternal deformity. Hypertrophic changes in the operative scar occurred in five patients (4.6%). Hypertrophic scar occurred more frequently as patient age increased (P<0.001).
CONCLUSIONS: In our study, neither operative nor demographic factors affected sternal deformity degree. The incidence of hypertrophic changes in the operative scar increases with age at the time of surgery.
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