The Nuss procedure also aims to force the sternum forward and hold it there with an implanted steel bar, but without making a big incision to resect the abnormal cartilage. In this procedure, the curved steel bar is placed under the sternum through two small incisions on the sides of the chest. Because the sternum is forced outward and held under great pressure, the Nuss procedure results in more pain and discomfort than the modified ravitch procedure. The steel structs must remain in place for approximately 2-4 years in order to properly reform the chest.
While less invasive than the Ravitch procedure, the initial Nuss procedure surgery still requires 4-5 days of hospitalization for pain management due to the rather drastic change in chest shape. Full recovery can take several weeks, during which time the patient's physical activities are restricted. For both the modified Ravitch and the Nuss procedures, the bar removal operation is a much simpler outpatient surgery, and the patient can usually leave within a couple hours.
Homecare After Nuss Procedure
The pectus repair is a painful procedure. Length of stay is dictated by postoperative pain management. Following the operation, most children stay in the hospital for approximately 5 days. An epidural catheter, placed in the back, will be used to give continuous pain medication. This is used for several days, when the pain is the greatest. While the epidural is in place, your child will have a catheter in the bladder to drain urine, and may be given oxygen by a small tube under the nose. After a few days, pain medication is given by mouth and the epidural is removed. In some children it may be necessary to place small tube(s) in the incision to drain fluid. These are removed when the drainage stops, usually after several days.
You can help speed your child's recovery by encouraging activities such as deep breathing, walking and sitting in a chair, as soon as possible after the operation.
A prescription for pain medication will be given to you to take to your local pharmacy at discharge.
Care for Dressings
Gauze and clear plastic dressings, placed over the incisions, may be removed a few days after surgery. Over the incision(s), there will be Steri-strips®, on which there may be a small amount of blood. This is normal. The skin surrounding the incision may be red and bruised, and the incision may be slightly swollen. Your child can bathe with the Steri-strips® in place. They will fall off on their own.
In most operations, the wound is closed with dissolvable suture(stitches). These stitches are under the skin and do not have to be removed. In some children these stitches may come through the incision about 4 weeks postoperatively. This may be associated with a little local redness and pus and it may involve an end of the incision or a larger portion. This is normal and is best treated by gently cleansing the area with soap and water and waiting. When the suture falls out or completely dissolves, the wound will heal. If your child has worsening redness, swelling pain of the incision and a fever within 2weeks of the operation, please call our office.
There may be some swelling of the incision. After the incision is healed you will be able to feel a firm ridge under the incision. This is called a "healing ridge" and it is where the tissues are sewn back together. It usually is present for several months.
Your child may bathe or shower after the epidural catheter is removed. Once your child is home, he or she may bathe or shower without restriction.
In order to avoid dislodging the pectus bar, we recommend no contact sports for at least one month following surgery. Except for these restrictions, your child can go about his or her activities as usual.
Do I see the surgeon again after the operation?
If all is going well, we recommend a visit to our office between two and four weeks after hospital discharge. A visit with your child's pediatrician one to two weeks after the discharge is also a good idea. You should call our office if you are worried about how things are going once your child is home.
When do I call the surgeon's office?
Call our office at 415-476-2538 for the following:
- Any concerns you have about your child's recovery
- A temperature of 101°F or higher
- Increasing pain and tenderness at the incision
- A red incision
- Any fluid coming out of the incision
When are the metal struts/pectus bar removed?
With an open or traditional repair, the metal struts are removed one year after insertion. A pre-surgical visit is required. Removal takes about one hour and is done as an outpatient procedure so that you can return home with your child the same day.
With the minimally invasive repair, the pectus bar(s) is (are) removed two years after insertion. This is also an outpatient operation that takes about one hour. A visit to our office is required at one year and again at 2 years, just prior to removal.