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• W2519966225 abstract "Sir: We have read the discussion of Wurtz et al. concerning our recent article1 and thank the authors for the interest they have shown in our work. They offer our team (i.e. plastic surgeons, thoracic surgeons, and pneumologists) the opportunity to reiterate our important message: after 476 cases of pectus excavatum operated on, the patients’ requests were only concerning the correction of a chest deformity, which bears a heavy psychological impairment, but never of lung or cardiac functional problems or any other type of functional complaint. Therefore, during this period, we were in agreement with the thoracic surgery and pneumology departments to proceed, for all cases, with custom-made implants and to withdraw the sternochondroplasty procedure. Since 1993, they stopped the Ravitch procedure for pectus excavatum but not for pectus carinatum. We have systematically informed our patients of the three main procedures (Ravitch, Nuss, and implants) according to their functional context. For the past 2 years, all patients across France have had their quality of life (Medical Outcomes Study Short-Form 36-Item Health Survey) and cardiopulmonary function evaluated by a pulmonary unit directly before the procedure and 1 year after. The results have not yet been published; however, they do not show the same results as in the original article published by Wurtz et al.2 Indeed, our results are within the normal limits. It is true that some patients may have some preoperative limitations, but this is because of a very common lack of sport training. The improvement measured after the Ravitch procedure is +2.7 ml/kg/minute, which is low and not clinically significant. Concerning cardiac function, we have the same question: Why operate on patients that have no functional problems? We maintain that orthopedic procedures are much harder on patients. We point out the higher cost for health insurance in terms of medicosocial expenses. Is this the best or even an ethical choice when the patient’s complaint is only aesthetic?3 We agree with Wurtz et al. on the major risks of the Nuss method, which they criticize in a recent article,4 so we reflected this in our article. However, we have also performed implant procedures to correct poor results after the two orthopedic methods: displacement of the steel material (Fig. 1), and overcorrection or recurrence (Fig. 2) in the Ravitch method.Fig. 1.: Bar displacement after a Ravitch procedure.Fig. 2.: (Left) Hypercorrection “carinatum” after a Ravitch procedure. (Right) Recurrence after a Ravitch procedure.As a conclusion, Wurtz et al. consider that we “underestimate the impact of pectus excavatum on cardiopulmonary function”: we still think among all our distinguished colleagues that there is no impact at all. They say that we “neglect the well-known negative long-term consequences of such anomalies after which a purely cosmetic procedure would have been applied”; however, our view is to the contrary. With regard to our experience over several disciplines, after 23 years, no patient has come back to us with any major complaints; neither the youngest nor the oldest of them has experienced any worrying symptoms. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this communication. Jean-Pierre Chavoin, M.D.Plastic Surgery and Burns UnitToulouse UniversityRangueil Teaching Hospital Marcel Dahan, M.D.Thoracic Surgery and Lung Transplantation Unit Elise Noel Savina, M.D.Pulmonary Function Exploration and Sports Medicine Unit Alain Didier, M.D.Pneumology UnitToulouse UniversityLarrey Teaching HospitalCHU Toulouse Benoît Chaput, M.D.Plastic Surgery and Burns UnitToulouse UniversityRangueil Teaching HospitalToulouse, France" @default.
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• W2519966225 date "2017-01-01" @default.
• W2519966225 modified "2023-09-27" @default.
• W2519966225 title "Reply" @default.
• W2519966225 cites W2110780007 @default.
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• W2519966225 doi "https://doi.org/10.1097/prs.0000000000002886" @default.
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