It occurs in 0.6-2.3 % of the child population. The cause of VVDGK is not fully understood . There are more than 30 different explanations for the causes of VVDGK . Underlying causes are delayed development ( dysplasia) costal cartilage, sternum , not matching the growth rate of the ribs and diaphragm in the anterior- posterior direction . Stunted diaphragm keeps the sternum , in connection with which the distal ribs and costal cartilages are deformed, forming a funnel-shaped recess anterior chest wall . In some patients, the deformation is a family history (hereditary ) character.
During VVDGK tends to progression . When VVDGK besides cosmetic defect , which often pay attention to parents and patients also develop dysfunction of the cardiovascular and respiratory systems , leading in severe cases to early disability and even a shortened life expectancy .
There are three degrees VVDGK , which are determined by the degree of retraction of sternum , expressed in centimeters ( 0.12 cm , 4.2 cm , and more than 4 cm in N.I.Kondrashinu ) or by calculation of the index Gizycko . Index is calculated as the ratio Gizycko shortest distance between the rear surface of the sternum and the anterior surface of the vertebral body at the maximum retraction to the greatest distance between the inner surface of the sternum and the anterior surface of the vertebral body , defined on the side of chest radiography . VVDGK largest first degree corresponds to the value of the index of more than 0.7 Gizycko , stage II . – 0,7-0,5 , Article III . – Less than 0.5.
Deformation of the anterior chest wall may be flat or deep , symmetric or asymmetric .
When compensated stage VVDGK holds only a cosmetic defect , the function of the chest is not broken . When subcompensated form functional disorders of the respiratory and cardiovascular systems expressed mild , with decompensated form VVDGK functional disorders of the pulmonary and cardiovascular systems are pronounced and it is they, and not a cosmetic defect , is an indication for surgical treatment.
There are more than 50 methods of surgical treatment VVDGK . The clinic spine surgery “Institute of Traumatology and Orthopedics of NAMS of Ukraine” , use the following procedure : a cross- operative approach , below the breasts. Performed the intersection of edges on the outer perimeter funnel rib cartilage at the edges of the sternum , obsekaetsya xiphoid sternum and broken – diaphragmatic ligament ( Mooring ) , a longitudinal incision from the sternum level 4 and below the ribs . Mobilized front chest wall is displayed in the correct position and locked metal latch conducted transversely across the body of the sternum and the ends of the clip fit the edges outside of the outer perimeter of the funnel. Lock fixed to the ribs. Under the sternum and below the upper skin and fascial flap summed drainage tubes , ensisternum sutured to the sternum . Sewn with a soft cloth . The rise of the patient to hold his feet on the second day , sutures are removed after 2-3 days. After removing the stitches on the 7-10 day of the patient is discharged home.
Radiographs before and after surgery
During the year, recommended the restriction of exercise and relief from physical education classes . Metal clip is removed after a year.
The positive results of surgical treatment VVDGK observed in 95 % of patients.
Minimally invasive reconstruction of the chest by a modified method of Nuss.
Minimally invasive surgery involves the installation Nuss’a metal plate that is inserted through a small incision on the side surfaces of the thorax. The plate is rotated through 180 degrees , a concave plate beneath the breastbone that instantly smoothes the retraction of the chest wall. The plate is attached to the sides of the breasts and ribs and left in place for 2-3 years , and then removed .