An evaluation of operative outcome in patients with funnel chest diagnosed by means of the computed tomogram

A questionnaire survey of 66 patients with funnel chest who underwent corrective surgical procedures by the sternal elevation method, with or without the application of a mental strut, demonstrated that the operative result was good in 60.6% and fair in 39.4%. None of the patients rated the result as unsatisfactory. A computed tomogram of the chest wall was performed to study the depression (b/c), asymmetry (b'/b), and flatness (a/b) of the chest wall, where a was the maximum transverse distance of the chest wall, b and b' were the maximum distance from the anterior to the posterior chest wall at the left and right sides (b > b'), and c was the perpendicular distance from the point of the anterior chest wall at its greatest deformity to the level of the anterior tip of the spine. In patients with a good result, b/c and b'/b were well corrected, while in patients with a fair postoperative result, they were still significantly different from those in subjects with normal chest walls. Moreover, 85.7% of the patients (6/7) with b/c over 3.0 before operation had a fair postoperative result. The degree of a/b was not corrected in patients with either good or fair postoperative results. We conclude that an operative approach to lengthen ribs would be necessary to improve the degree of a/b, that in patients with severely depressed funnel chest, expressed as a b/c value over 3.0 by computed tomography, a transient support with struts should should be applied, and finally, that a more careful approach for correction of asymmetry should be undertaken to improve the operative results.