The Institute of Chest Wall Surgery
SADDLE CHEST
Introduction
Causes
Saddle chest is a relatively uncommon type of complex chest wall deformities characterized by distinctive morphological features. Therefore, to clearly distinguish it from other general complex deformities during diagnosis and treatment, Dr. Wenlin Wang named this specific condition “saddle chest.”
The main characteristic of saddle chest is the presence of symmetrical indentations on each side of the lower chest wall. The two depressions are not connected. Instead, they are separated by the normal height of the chest wall in the center, giving the overall chest wall the appearance of a saddle. Therefore, saddle chest is essentially a combination of two depressions of lateral chest wall.
Symptoms
The exact cause of primary saddle chest remains unclear. It may be associated with the development and advancement of Harrison’s groove; nevertheless, not all instances of primary pectus carinatum are correlated with Harrison’s groove.
Secondary saddle chest commonly develops after the Nuss procedure for pectus excavatum, representing a common complication of the surgery.
Diagnostic Methods
When the depressions are severe and compress the heart and lungs, patients may experience symptoms such as chest tightness, palpitations, chest pain, and even breathing difficulty. Additionally, the physical appearance of the malformation often causes feelings of inferiority in many patients, and can sometimes lead to varying degrees of psychological issues.
Surgical Procedures
Diagnosis primarily involves a physical examination by observing the appearance of the chest wall, supplemented by imaging examination such as X-ray, chest CT scan, and three-dimensional reconstruction imaging.
To correct the depressions on both sides of the chest wall, either the Wang procedure or the Wung procedure will be performed twice, requiring only one bar to complete the operation. This surgical approach significantly simplifies the operative process, reduces the risks and complexity of the surgery, and can achieve more ideal corrective outcomes.
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Open Surgery
This surgery involves using MatrixRIBs to extend and shape segments of the ribs or costal cartilage on both sides of the chest wall. The shaping material used does not require removal, thereby averting the need for subsequent surgery and associated discomfort.
FAQ
Surgical Outcomes and Expectations
A: No, saddle chest rarely improves without surgical intervention and often becomes more pronounced with age, especially during puberty when the bones of the chest wall develops rapidly. If the depression compresses internal organs and causes symptoms such as chest tightness, palpitations, upper abdominal pain, or bloating after meals, surgery should be considered.
A: Typically, 2 small incisions are made, one on each side of the chest.
A: In most cases, 2 bars are required. The exact number depends on the patient’s condition and the surgical plan.
A: Saddle chest is a potential complication of the Nuss procedure, mainly related to surgical technique. During the operation, when bars are employed to elevate the central concavity of the chest wall, the lateral chest walls act as fulcrums and are subjected to substantial pressure. If the bone strength at these fulcrum sites is inadequate, depressions may form on both lateral chest walls, leading to saddle chest.
A: In most cases, the deformity is significantly corrected right after the procedure, resulting in a chest wall that appears close to normal. Following this initial correction, the chest continues a process of slight, gradual remodeling over time. The new contour is typically well-established within about 3 months and fully stabilizes after 2 to 3 years.
A: The total cost usually ranges from $7,000 to $10,000. The exact amount will be determined by factors such as the patient’s condition and the specific surgical plan.
Postoperative Care and Pain Management
A: It is common to experience significant pain in the initial postoperative period, particularly among adolescent and adult patients due to their more rigid skeletal structure. Our hospital employs a comprehensive, multi-modal analgesia protocol to ensure effective pain control. This integrated approach includes:
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Intraoperative Intervention: Intercostal nerve blocks are administered to prevent pain signals from transmitting.
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Postoperative Medication: Continuous pain management is delivered through a patient-controlled analgesia (PCA) pump, supplemented with scheduled intravenous analgesics.
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Adjunctive Rehabilitation Therapy: Our dedicated rehabilitation team provides personalized physiotherapy, incorporating techniques such as acupuncture, therapeutic massage, electrical stimulation, and ultrasound therapy. These modalities are highly effective in alleviating localized pain and common discomforts like postoperative bloating.
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A: Most patients stay in the hospital for around 7 days, although the actual duration depends on individual recovery.
Postoperative Recovery and Activity Guidelines
A: The risk is very low. The bars used in surgery are made of titanium alloy, which provides excellent rigidity and resistance to deformation. In addition, the Wang Technique, a cutting-edge bar fixation method, is utilized during surgery to rigidly stabilize the bars in position, effectively preventing displacement. Long-term clinical data confirms that the vast majority of patients do not experience bar displacement or deformation. It is crucial to note that during the early postoperative period (within the first 3 months), patients should avoid vigorous exercise and be mindful in their daily lives to avoid significant impact or trauma to the chest, thereby reducing the likelihood of bar displacement.
A: Most patients can get out of bed and walk within 3–4 days after surgery, and resume daily activities around 10 days postoperatively. Patients can usually return to normal work or school (excluding heavy physical labor) around 1 month. Light exercise, such as jogging or hiking, can start within the first three months, with intensity gradually increased thereafter.
It is crucial to note that if you encounter any discomfort, such as chest pain or shortness of breath, during exercise, you should stop the activity immediately. If necessary, a chest X - ray or CT scan can be arranged for further examination.
A: Yes, for the initial postoperative period, maintaining a specific sleeping position is important for healing. It is advised to sleep in a supine position (lying on your back) or a modified lateral position (partially reclining on one side) for the first month , adjusting as needed for comfort around the incision sites. Additionally, you need to avoid making large - scale body movements, like chest expansion, bending over, and lifting heavy objects. After about a month, once your incisions have completely healed, you can gradually start sleeping on your side.
A: After the drainage tubes are removed (the removal time is determined by the drainage volume and follow - up examination results, generally within 1 - 2 weeks), you can take a shower with the wound covered by waterproof dressings. After the shower, replace the dressings with breathable gauze to protect the wound. Around 3 weeks after surgery, once the incisions have completely healed, you can take a normal shower.
Complications and Follow-up
A: Our discharge protocol is designed to ensure your safety. Typically, patients can be safely discharged 7 - 10 days post-surgery. After about one week of observation post-discharge, the risk of the vast majority of complications can generally be excluded. If recovery progresses smoothly during the first three weeks post-surgery, the likelihood of later complications is extremely low. Additionally, the bars are firmly secured, and the surgical technique is specifically designed to prevent issues like bar displacement.
However, if you notice symptoms such as pneumothorax, pleural effusion, significant pain, or poor wound healing, please contact our doctors promptly. In case of an emergency, please seek immediate care at a local hospital.
A: If your recovery goes well without any noticeable discomfort or abnormal conditions, regular follow-up is usually not required. However, if you develop symptoms such as persistent high fever (temperature >38.5°C), sudden chest tightness, shortness of breath, or difficulty breathing, please have a chest X-ray or CT scan locally and consult a thoracic surgeon or our doctor for further guidance.
The bars are usually removed three years after surgery, with the exact timing determined by the patient’s recovery and doctor’s evaluation.
Other Issues
A: Yes. Upon discharge, we will provide a discharge summary and a medical certificate. If airport security raises any concerns, presenting these medical documents will facilitate your passage.
In most cases, taking a flight does not cause discomfort, you can travel with confidence.
A: Optimal nutrition is crucial for healing. We recommend the following dietary plan, tailored to your recovery phase:
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Initial Phase (during bed rest): Choose easily digestible semi-liquid foods, such as porridge, juice, or well-cooked noodles.
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Recovery Phase (once able to get out of bed): Gradually resume a normal, balanced diet with an emphasis on high-quality protein sources such as fish, chicken, and eggs. Make sure to eat fresh fruits and vegetables daily to supplement vitamins and electrolytes.
Precautions: Strictly avoid spicy and greasy foods, and be cautious with foods that may trigger allergies, such as seafood or mangoes.
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