OBJECTIVES: To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS: Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS: Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11-40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION: In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com) and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

INTRODUÇÃO: O pectus excavatum (PEX) caracteriza-se por depressão do esterno em relação ao gradeado costal. Medidas clínicas e objetivas para classificar esse defeito são raras e de difícil aplicação. Este trabalho tem por objetivo criar um índice antropométrico para PEX (IA) como método diagnóstico e de avaliação pré e pós-operatória, comparando-o ao índice de Haller (IH) e ao índice vertebral inferior (IV). MÉTODOS: No período de dezembro de 2001 a fevereiro de 2004 foram estudados dois grupos de pacientes no Serviço de Cirurgia Torácica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP): a) 30 pacientes com a caixa torácica com configuração normal ao exame físico; b) 20 pacientes portadores de PEX. Estes últimos foram operados pela técnica de Ravitch modificada por Robicsek e pelo Serviço de Cirurgia Torácica do HC-FMUSP, sendo estudados no pós-operatório. Todos os pacientes foram avaliados a partir do IA (medidas clínicas), do IH (medidas tomográficas) e do IV (medidas radiográficas) no nível da maior deformidade (MD), no caso dos PEX e no terço distal do esterno (TD), nos normais. Os pacientes operados foram novamente medidos entre o 60º e o 80º dia do pós-operatório. RESULTADOS: Houve elevada correlação entre o IA e o IH (80% p< 0,001) e entre o IA e o IV (79% p< 0,001). A acurácia dos três índices foi similar, sendo que se estabeleceram os seguintes pontos de corte: IA= 0,12; IH= 3,10; e IV= 0,25. Ao ser analisado o pré-operatório, foi verificado para os três índices, que mais de 75% dos portadores de PEX encontravam-se acima dos pontos de corte e foram confirmados como portadores do defeito. No pós-operatório os valores dos índices encontrados abaixo do ponto de corte foram considerados dentro do padrão normal e isso ocorreu em 100% para o IA, em mais de 50% para o IH, e em 50% para o IV. CONCLUSÕES: O IA permitiu mensurar adequadamente o defeito, mantendo: a) alta correlação com o IH e o IV e elevada acurácia, semelhante à desses índices já consagrados; b) eficaz comparação entre o pré e pós-operatório.

BACKGROUND: Pectus excavatum (PEX) is a depression of the sternum in relation to the costal cartilages. Clinical and objective measures for classifying the defect are rare and difficult to apply. The present study aimed to create an anthropometric index (AI) for PEX as a method for diagnosis and for preoperative and postoperative assessment by comparing it to the Haller index (HI) and to the lower vertebral index (LVI). METHODS: From December 2001 to February 2004, 2 groups of patients were studied at our institution: a) 30 patients with normal configuration of the thoracic cage, upon physical examination; b) 20 patients with PEX. The latter underwent surgery according to the Ravitch technique modified by Robicsek, and they were evaluated in the postoperative period. All patients were assessed by means of the AI (clinical), HI (tomographic), and LVI (radiographic) measures at the level of deepest deformity in the case of the PEX patients, and in the distal third of the sternum in the normal patients. The patients who had undergone surgery were once again measured between the 60th and the 80th postoperative days. RESULTS: There was a high correlation between the AI and the HI (80% P < .001) and between the AI and the LVI (79% P < .001). The accuracy of the 3 indices was similar, in that the following cut points were established: AI = 0.12, HI = 3.10, and LVI = 0.25. Upon analyzing the preoperative results, we verified that for the 3 indices, over 75% of the patients with pectus excavatum were above the cut points and were confirmed as having the defect. In the postoperative results, the value of the indices found below the cut point was considered within the normal standard, and this occurred in 100% for the AI, in over 50% for the HI, and in 50% for the LVI. CONCLUSIONS: The AI allowed adequate measurement of the defect, maintaining a) a high correlation with the HI and the LVI and a high accuracy, similar to the already acknowledged and published indices and b) an efficient comparison between the preoperative measurement and the postoperative results.

INTRODUÇÃO: O pectus excavatum caracteriza-se por uma depressão do esterno e das cartilagens para-esternais inferiores. Medidas clínicas para classificar essas depressões são poucas e de difícil aplicação. OBJETIVO: Criar medidas clínicas para quantificar a deformidade e poder comparar os resultados entre os períodos pré e pós-operatório. MÉTODO: Dez pacientes portadores de pectus excavatum, foram operados utilizando-se a técnica de Robicsek modificada pelo grupo de Cirurgia Torácica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, sendo também medidos clínica e radiologicamente nos periodos pré e pós operatõrio. Dez pacientes controles que não apresentavam anormalidades torácicas clínicas e ou radiológicas foram medidos da mesma forma. O defeito foi avaliado no nível do manúbrio e da maior deformidade através do índice antropométrico e do índice de Haller. RESULTADOS: A análise multivariada para as médias do índice antropométrico mostrou diferenças significativas entre o pré operatório e o grupo controle e entre as médias do pré e do pós operatório, e diferença não significativa entre o pós operatório e o grupo controle. A mesma análise, aplicada às médias do índice de Haller, demonstrou os mesmos resultados. O estudo pareado entre as médias do pré e do pós operatório mostrou tratarem-se de grupos diferentes. A correlação canônica evidenciou que o índice antropométrico e o índice de Haller têm correlação de 86%. CONCLUSÃO: Pacientes portadores de pectus excavatum podem ter a deformidade quantificada através de medidas do índice antropométrico no pré e no pós operatório, as quais permitem uma avaliação objetiva e comparativa dos resultados, e são de fácil realização.

BACKGROUND: Pectus excavatum is characterized by concave growth of costal cartilage and depression of the lower sternum. Clinical means of classifying these malformations are few and difficult to apply. OBJECTIVE: To devise clinical tools for quantifying the deformity and comparing preoperative and postoperative findings. METHOD: A total of 10 pectus excavatum patients who underwent surgery in which the modified Robicsek technique was used by the Thoracic Surgery Group of the Hospital das Clínicas of the University of São Paulo School of Medicine, were clinically and radiologically evaluated in the preoperative and postoperative periods. Ten control individuals, presenting no thoracic or radiological abnormalities, were submitted to identical evaluations. Deformities at the sternum notch level and at the point of maximum deformity were assessed using the anthropometric index and the Haller index. RESULTS: Multivariate analysis of anthropometric index means revealed significant differences between preoperative and control values and between preoperative and postoperative values, as well as a non-significant difference between postoperative and control values. The same results were obtained when Haller index means were analyzed. A paired comparison of preoperative and postoperative means showed two distinct groups. An 86% canonical correlation was found between the anthropometric index and the Haller index. CONCLUSION: Patients with pectus excavatum can be quantitatively assessed in the preoperative and postoperative periods through the use of the anthropometric index, which allows objective, comparative evaluation of the results and is easily performed.