Penningtons Manches’ cosmetic surgery team is currently investigating a potential clinical negligence claim in relation to the NUSS procedure, an unusual operation which is used to correct 'pectus excavatum', colloquially known as 'funnel chest'.
Pectus excavatum, a Latin term meaning 'hollowed chest', is a congenital deformity which develops when several ribs and the sternum grow abnormally. This produces a sunken appearance and although the problem is considered to be mainly cosmetic, it can also impair both cardiac and respiratory function.
There are a number of treatment options available for pectus excavatum, both invasive and non-invasive. The vacuum bell is a relatively new alternative to surgery and consists of a bowl-shaped device which fits over the depressed area. Air is then removed from the device with a hand pump, creating a vacuum which lifts the sternum upwards, lessening the severity of the deformity. This vacuum needs to be used repeatedly and for an additional two years after the defect disappears in order to achieve a permanent correction. Alternatively, dermal filler or implants can be used to fill the depressed area and to improve cosmetic appearance. Another option, suitable for mild cases, is the use of corset-like orthopaedic support vests and exercise.
Surgery is the only option that can repair functional symptoms, as well as provide a cosmetic improvement. A number of different methods are applied. The most popular surgical procedure uses the NUSS technique which is considered to be minimally invasive. It involves one or two concave metal bars being moulded to the shape of the patient's chest and inserted, back-to-front, underneath the sternum and ribs. Once in place, the bars are flipped, to force the sternum outwards and into a more 'normal' shape. To support the bars, a metal stabiliser plate is inserted. The bars are usually left in place for between two and four years and are removed once the bones have solidified in the correct position.
Penningtons Manches’ cosmetic surgery specialists have been instructed to examine an NUSS procedure performed on a patient who wanted to improve the cosmetic appearance of his funnel chest. He understood that two bars were required in adult procedures because the muscle and cartilage is much stronger, meaning more force is needed in order to correct the defect, and was told that these bars would be inserted horizontally.
When the patient woke up from surgery, he was informed that although the surgeon had tried to insert two bars, it had made his chest look too barrel shaped and the surgeon had therefore decided to remove the second bar. He had then re-bent the single bar so that it could be inserted in a different position. It has since become apparent that the single bar was inserted diagonally rather than horizontally.
After the surgery, our client was in severe pain and had difficulty breathing because he had developed pleural effusion and a partially collapsed lung. Initially, he believed the appearance of his chest had improved but once the swelling had gone down, it became apparent this was in fact worse. The depression was still noticeable and the diagonal bar, pushing out one side of his chest and not the other, had caused the hollow to become asymmetrical in appearance with one nipple drawn inwards.
Due to the lack of cosmetic improvement and the continuous excruciating pain, our client was advised that the only way forwards was to have the bar removed. He will now require treatment to correct his pectus excavatum, with significantly reduced chances of a successful outcome from future surgery because of the scarring and damage caused by the unsuccessful NUSS procedure.