The operative treatment of the funnel chest.

The operative correction of the funnel chest is a difficult and important problem. Quite a number of methods and modifications have been mentioned. Late results, however, do not always come up to expectation. As a seriously deformed funnel chest may lead to troubles of the functions of the lungs and heart (Wegmann and Schaub, 1953; Schaub and Wegmann, 1954) operations should be limited to such cases only. Operating from a cosmetic point of view is not justified. The best age for a child to be operated on is 3 to 5 years. At this age we find an increased tendency to bronchitis, palpitation and delay of general physical development. Very serious disorders of the functions of the lungs and heart become evident in the second decade. On close examination of children under 10 years of age, we often found a reduction in maximum breathing capacity at this age too, as also did Brown and Cook (1951). An abnormal E.C.G. generally due to abnormal location of the heart was observed, too, with patients less than 10 years old. Operating at an early age is primarily a preventive measure. In many cases surgery has been successfully performed in adults. The operation becomes more difficult because of greater rigidity. The result is mostly not so satisfactory as it would be with a child, but the patient is no longer endangered by growing factors. The so-called limited, or ligament-cutting operation, at first used by Brown (1939) on infants, is not performed very often. Hausmann (1955) recommends the complete operation as early as the age of 2 years. Quite irrespective of whatever method may be applied, the operation is divided into two parts: mobilization and stabilization. Methods differ, in particular in the course of stabilization, whereas with regard to mobilization variations to any great extent are not possible.