Treatment of Pectus Excavatum Using a Vacuum Bell
Information on the treatment of Pectus Excavatum with a vacuum bell primarily circulates among surgeons and paediatricians. Such information is only really made available to patients refusing operative cosmetic treatment. This post attempts to convey the key points associated with vacuum bell therapy in order to better inform those seeking a treatment from Pectus Excavatum.
The vacuum method was used as early as 1910 by Lange for elevating the sternum, but was not applied to a large number of patients, and long-term results were not documented. The modern vacuum bells used in the treatment of Pectus Excavatum are the Costa and Klobe vacuum bells. Additionally, it is important to note that the engineers of both products suffered from Pectus Excavatum themselves before using a vacuum bell to treat the condition.
Initial results of vacuum bell treatment have proved dramatic, and the acceptance and compliance of patients seems to be good. In many cases of Pects Excavatum, the degree of the deformity does not immediately warrant cosmetic surgery, yet patients may greatly benefit from some type of non surgical treatment. Other patients are disinclined to undergo surgery because of possible complications associated surgery and post operative recovery or because of the pain associated with cosmetic surgery, not to mention the risk of imperfect results. Thus, the introduction of the vacuum bell for the conservative treatment of Pectus Excavatum has generated much interest among patients with the disorder, particularly given the positive effects experienced by those undergoing vacuum bell treatment.
However, the success of vacuum bell therapy not only requires a good technique, but also depends on an appropriate patient vindication/determination. This is evident from the results of a recent medical study:
- Patients with symmetric and mild Pectus Excavatum seemed to show a more successful outcome than those with asymmetric and deep Pectus Excavatum
- The application of the vacuum bell was well tolerated by both paediatric and adult patients.
- All patients except one were satisfied with the use of the vacuum bell, although objectively assessed improvement of Pectus Excavatum varied between the individuals.
- All our patients were recommended to carry on undertaking sports and physiotherapy, so that the accompanying improvement of body control was an important factor in outcome.
- The participation of patients themselves in the ?active? treatment of Pectus Excavatum clearly increases motivation to maintain therapy.
- The manufacturers instructions and our treatment protocol recommended application of the device twice daily for 30 min each. However, the definitive duration and length of use was determined by the individual patient and the parents, respectively.
- As proved using a the CT-scan, the force of the vacuum bell is strong enough to deform the chest within minutes.
- The application of the vacuum bell has to be performed carefully
For more information about this medical study, please read this post.
When creating the vacuum, the elevation of the sternum is obvious and persists for a distinct period of time. Therefore, the vacuum cup may also be useful in reducing the risk of injury to the heart during the MIRPE procedure, where the riskiest step of the procedure is the advancement of the introducer between the heart and sternum. Since the manufacturers of the vacuum bell devices do not yet a license to sterilize the vacuum bell, this additional use has to be considered as a clinical trial. During this trial, in accordance with a hospital hygienist, the vacuum bell was applied during the MIRPE procedure in a few patients and produced a good experience and promising results. In addition, the vacuum bell may be useful in a way of ?pretreatment? to surgery, however, this hypothesis is yet to be confirmed.
To summarize, the vacuum bell can allow for patients with Pectus Excavatum to avoid surgery. Especially patients with symmetric and mild Pectus Excavatum, who semm to benefit most from this procedure. Additionally, the intraoperative use of the vacuum bell during the MIRPE may facilitate the introduction of the pectus bar, though this requires further evaluation. In any case, the method seems to be a valuable adjunct therapy in the treatment of Pectus Excavatum.