History of pectus excavatum1
Pectus excavatum was first recognized in the 1500’s. It was not until the early 20th century that thoracic surgery became a widely accepted discipline and it was in 1911 that the first surgical correction of pectus excavatum was attempted by Ludwig Meyer.
In the 1920s, a German surgeon named Ferdinand Sauerbruch performed the first pectus repair using a more aggressive technique. Dr. Sauerbruch removed cartilage from both sides of the chest and a cut was made in the breastbone to correct its shape. This technique was revised and popularized by Dr. Mark Ravitch who, in 1947, published his experience with eight patients using this extended modification of Saurebruch’s technique. Since the sternum was removed from all of its attachments, Ravitch believed the sternum would no longer sink back into the chest and eliminated the use of external traction. As a result, in 1956 Wallgren and Sulamaa introduced the concept of internal support by use of a slightly curved stainless steel bar, a bridge-like technique that created a gap between the chest bone and ribs. In 1961, Adkins and Blades took this concept of internal bracing and invented a stainless steel bar that would pass behind the sternum rather than through it; this form of pectus repair became the technique for patients of all ages for the next 40 years.
In 1986, Dr. Haller drew attention to the flexibility of rib cartilage and questioned its removal. He decided to operate on his next patient by not removing the skin and muscles off of the chest and kept the rib cartilage and sternum in place. His surgical technique without cartilage resection was the first real alternative to the Ravitch procedure.
In 1997, Dr. Donald Nuss, in cooperation with Walter Lorenz Surgical (Zimmer Biomet), developed a less invasive surgical technique and the Pectus Support Bar implant to remodel the chest wall over a two- to three-year period. This procedure, also known as the Nuss procedure, has shown strong success in patients, with a number of papers presented at national and international meetings8,9,10. This minimally invasive technique has impacted the lives of thousands of patients around the world.
