PMC3919108_01
A 9-year-old boy with symmetric chest wall deformity. The insertion point for the dissector was determined by CT examination. The insertion point of the Nuss bar on the left thoracic wall ( ). The depth between the body surface and the insertion point (*) was 7.5 cm.
eplasty14e08_fig1.jpg
PMC3919108_01_eplasty14e08_fig1.jpg
F1
On this image, a line was drawn from the insertion point of the Nuss bar on the left thoracic wall (Fig 1, white arrow) along the retrosternal plane (Fig 1, red arrow). The depth between the body surface and the insertion point was 7.5 cm in this case (Fig 1*).
Intraoperative view of the same patient shown in Fig 1. (a) Intraoperative design. The dissector passed through from the same skin incision where the Nuss bar was to be inserted. (b) The right side of the mediastinum. Dissection of the mediastinum. The layer of the dissection was just above the pericardium (*). (c) The left pleura (*) and internal thoracic vessels ( ). Sufficient tissues were left in place to protect the internal thoracic vessels from damage. (d) Postoperative view.
eplasty14e08_fig2.jpg
PMC3919108_01_eplasty14e08_fig2.jpg
F2
From this evaluation, the dissector was inserted from the sixth intercostal space near the mid-axillary line (Fig 2a  ) and therefore skin incision was set up dorsally from the usual position. In dissection of the retrosternal space, we dissected just above the pericardia not just beneath the sternum to preserve sufficient tissues around both cardiac and internal thoracic vessels to protect them from damage (Figs 2b and 2c). A good result was obtained (Fig 2d).