A recent conversation on bracing for
pectus carinatum prompted a review of what’s new in the literature.
The principle of bracing relies on the application of
constant (23 hours a day) external pressure to a carinatum deformity using a
specially made padded brace. The
brace pressure is adjusted to the maximum tolerated by the patient and then
left in place until the deformity resolves (corrective phase). At that point, the patient goes into
the maintenance phase, where he/she wears the brace for 8 hours a day until the
end of the growth spurt.
In the current issue of JPS, Lee et al. looked at the
outcome of bracing for pectus carinatum in terms of average time for the corrective and
maintenance phases, compliance, and final outcome. They noted that, overall, the corrective phase lasted 7±7.3
months. The corrective phase was shorter (4.2±0.9 months) in kids who had not reached Tanner stage IV of maturity when compared to those who had (8.0±7.1 months); a statistically
significant difference.
Interestingly, 45% of their patients were considered
treatment failures, mainly because of loss to follow up (29%) or non-compliance
(15%).
The authors commented on the issue of compliance, suggesting
that the fact that results can be noted in as little as a month after brace
application encourages patients to accept increasing pressures and improves
compliance. However, more work is needed in researching causes of poor compliance and ways to improve it.
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