Rib osteotomy with the Nuss procedure for the repair of adult pectus excavatum.

For the Nuss procedure in adult patients with pectus excavatum, sufficient sternal elevation is difficult due to the rigid chest wall. To solve the problem, we present a novel rib osteotomy procedure. From the skin incisions on the lateral chest which are the common approach for the Nuss procedure, a surgical drill is used to incise bilateral anterior half of the rib cortex after installing the pectus bars. Osteotomy is done on the ribs next to the points where the bars penetrate the intercostal muscle. After making rib osteotomy, the ribs bend spontaneously like greenstick fracture. Elevation of the stiff anterior chest wall can be achieved by this procedure. Rib osteotomy is also beneficial for pain relief due to the reduction of the strain to the ribs. It could be expected that regression after bar removal is avoided.