STAGED APPROACH TO PECTUS EXCAVATUM
Stage 1 Posture assessment and improvement
Posture assessment and its improvement comes first. A rounded posture of the swimmers's slouch should be noticed. The hunched-over posture can be noticed in standing and sitting.
In order to effectively improve one's posture a various period of time is required, no less than several months to as long as a few years in young children.
Stage 2 can begin only when the patient's posture has improved.
Rounded shoulders result in sternal inversion and flaring ribs. With ageing, these changes become permanent
Radical change in posture demonstrates total improvement of chest anatomy
Stage 2 Mobilisation and elevation of the sternum
Eckhart Klobe - inventor od the vacuum bell
Female type
Male type sized 26,19,16 cm
How it works (by courtesy of Prof. F. Schier)
No suction
Suction/vacuum elevates the sternum and cartilages
In Stage 2 the depressed sternum and adhering cartilages are loosened off the bony ribs and elevated by means od negative pressure produced in the vacuum bell (Saugglocke, suction cusp). Negative pressure is rather mild and harmless except for possible petechiae , tiny blood spots which eventually fade away in time.
The sternum should eventually go well above the chest wall level to allow for its attaining normal level after removing the suction. It usually takes 1-3 months but may last a bit longer when skin petechiae appear due to too forciful suction or individual reaction to negative pressure.
Along with suction sessions intensive physiotherapy for posture improvement should not be neglected.
Stage 3 Stabilisation and further elevation of the sternum
In Stage 3 the loosened sternum requires fixation in a higher, normal position. In addition to continuing physiotherapy and applying suction breathing exercises are added to support the detached sternum from below. This stage is similar to Dr Haje's procedure who uses braces to the lower chest to relocate breathing to the depressed part of the chest. This usually needs as long as 2 years, but 4 years is not exceptional. By adding a vacuum bell the stage of mobilisation of the depressed chest becomes greatly reduced to several months only.
It is in Stage 3 that flaring ribs can receive their proper alignment by applying pressure using a brace or by strengthening oblique abdominal muscles with appropriate exercises.