Depression of lateral chest wall, a relatively rare type of chest wall deformity, refers to a significant indentation of the lateral chest wall with a clear base and elevated edges. Although its external appearance bears some resemblance similar to pectus excavatum, there are significant differences between the two. The affected areas of depression of lateral chest wall are limited only to the ribs and costal cartilages, while the sternum remains in a normal state with no abnormalities. In contrast, pectus excavatum is a condition that inevitably affects the sternum. Therefore, in terms of medical classification and treatment, depression of lateral chest wall and pectus excavatum have fundamental differences, which means that the treatment methods for the former cannot simply apply the traditional surgical approaches used for pectus excavatum, such as the classic Nuss procedure.

The exact cause of primary depression of lateral chest wall remains unclear. Secondary depression of lateral chest wall is often caused by empyema, with the root cause being the traction exerted on the chest wall by the fibrous structures on the inner side following pleural thickening. In addition, secondary depression of lateral chest wall can also occur after chest wall trauma. If the bone structure of the chest wall suffer extensive damage and is not securely fixed during surgery, a depression deformity may occur.

When the depression is severe and compresses the heart and lung, patients may exhibit obvious clinical symptoms, manifesting as chest tightness, shortness of breath, palpitations, chest pain, and other respiratory and circulatory discomforts. Additionally, some patients may also exhibit scoliosis.

Diagnosis involves assessing the patient’s clinical manifestations and physical signs, along with imaging examinations such as X-ray, chest CT scan, and electrocardiogram.

Modified Nuss Procedure:

This is a modified version of the Nuss procedure, specifically designed for the correction of depression of lateral chest wall. Due to the differences in the location and characteristics of deformities between depression of lateral chest wall and pectus excavatum, the standard Nuss procedure is not applicable. The modified Nuss procedure involves innovative modifications in the placement of the bar and fulcrum points, among other operative details, to ensure optimal correction results.

Modified Wang procedure

Although it differs from the standard Wang procedure in terms of operating details, it retains the core operative principles of the standard procedure, making this procedure simple, minimally invasive, and safe.