The patient, a 27-year-old man, has had chest wall deformity since puberty, which have progressively worsened over time. This deformity has not only led to respiratory symptoms such as chest tightness and palpitations but has also caused significant psychological distress, prompting him to undergo surgical treatment.
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Medical History
Preoperative Examination
The upper part of the patient’s chest wall is protruded as a whole, coupled with depressions in the central and lower regions, presenting a classic example of Wenlin chest.
Surgical Overview
Initially, a 3 cm incision was made on each side of the lateral chest wall. Another incision of the same size was then made at the center of the chest wall to expose the affected sternum and surrounding costal cartilages. Pre-shaping is performed on the bone structure of the malformed area. Subsequently, three bars were inserted, followed by the Wenlin procedure and the Wung procedure were performed to correct the protrusions and depressions respectively. The operation proceeded smoothly, and the deformity was corrected after surgery.
Related Photos
The entire upper chest wall protrudes forward, while the lateral wings and the middle-lower part are concave.
The X-ray indicates a slight rightward shift of the heart
The X-ray indicates a protrusion in the upper part of the anterior chest wall, with a depression below the middle portion.
The CT scan shows the entire upper chest wall protrudes forward as a whole
The CT scan shows the lower half of the chest wall is indented
The 3D reconstruction displays a typical Wenlin chest contour
3 bars that were placed during the surgery
The 3 cm incision on the lateral chest wall
The 3 cm midline incision on the chest wall
After the surgery, the chest wall appears normal with the deformity eliminated
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The Specificity of Wenlin Chest
Wenlin chest is a distinctive chest wall deformity that was often mistakenly identified as pectus carinatum in the past. However, unlike PC, which is characterized by a single protrusion, Wenlin chest involves both protrusions and depressions, classifying it as a kind of complex chest wall deformities. This malformation can not be corrected by traditional surgeries that work for PC. Notably, the depression in Wenlin chest is only apparent in comparison to the protrusion of the upper chest wall, without significantly compressing the patient’s heart.
Given that Wenlin Chest is a kind of complex deformities, the Sandwich procedure might be considered for treatment. However, this approach faces significant challenges due to the extraordinary hardness of the deformed sternum, which makes it difficult to achieve desired shaping outcomes.
To effectively correct this deformity, the concept of pre-shaping has been adopted in surgery. Initially, by employing pre-shaping techniques to even out the height difference between the protrusion and depression, the Wenlin chest is transformed into PC, followed by further correction of the convex deformity. Consequently, the surgical treatment of Wenlin chest becomes more minimally invasive and effective.
