Pectus Carinatum Treatment: Why Remote Care Works

History of Pectus Carinatum Treatment

Pectus carinatum (also known by the common name pigeon chest) was first recorded by the ancient Greek physician Hippocrates (460-370 BC), who stated that “the chest becomes sharp pointed and not broad, becomes affected with difficulty of breathing and hoarseness; for the cavities which inspire and expire do not obtain proper capacity.”[1] He also noted that the sufferers generally had their heads bent forward. At that time, there was no treatment available for this condition and no treatments appear to have been reported until much more recently. 

Interestingly, one female Yorkshire skeleton from the late 15th century AD shows evidence of pectus carinatum which may have been treated with external compression treatment (i.e. bracing or strapping).[2] There is no firm evidence that this was the case; however, a similar case has been reported from another 19th century skeleton from Wolverhampton. This male skeleton also showed signs of pectus carinatum which may have been treated by use of an orthopaedic corset.[3] 

In the modern era, Dr Mark Ravitch provided one of the first reported surgery methods in 1960.[4] The Ravitch procedure, along with the Abramson procedure,[5] remains one of the most commonly used surgical treatments for pigeon chest today. Essentially, surgical treatment of pectus carinatum involves making an incision down the chest to access the breastbone, cutting out the protruding sections of cartilage, and repositioning the breastbone further down in the chest (if necessary).

In addition to being invasive and expensive, the extended recovery process can be quite painful. Consequently, in the past two decades, non-surgical treatment using an orthotic brace has become the recommended first line of treatment for the majority of patients who are still growing or have flexible chests.[6] 

Brace Treatment of Pectus Carinatum

Pectus carinatum braces are designed to compress the chest around the protruding breastbone region. Over an extended period, this remodels the growth pattern of the breastbone cartilage, reshaping the breastbone region to the desired shape.[7] The best results are found in younger children, as the cartilage forming the breastbone is more flexible and pliable in these patients. Nevertheless, chest braces are quite effective in treating pigeon chest in most patients,[8] often with favourable results seen in just 6-12 months. Compliance (i.e. wearing the chest brace when prescribed) is one of the main factors affecting the efficacy of pectus carinatum braces.[9]

Consequently, the brace should be well-suited to the individual patient’s condition and body shape. Custom braces, such as those produced by Dakota Brace, are 3D printed to match a 3D scan of the patient’s chest, ensuring an ideal fit. This provides superior results to generic braces, such as those available on eBay or Alibaba. Furthermore, the cost of 3D braces manufactured by Dakota Brace are as low as $1200, in contrast to traditional custom-made braces, which may cost upwards of $4000.

Traditionally, obtaining a custom pectus carinatum brace has required extended in-person consultations, chest scans, and follow-up consultations to ensure the shape is correct. However, recent developments have made it possible to conduct all of these steps remotely using telemedicine.

Remote Treatment vs In-Person Treatment

But how does remote treatment for pectus carinatum work? And is it as effective as in-person treatment?

One recent clinical trial investigated the use of telemedicine for treating patients using pectus carinatum braces during the COVID-19 pandemic.[10] The authors found that patients who used telemedicine were significantly more likely to continue their bracing treatment compared to those who used in-person treatment. The use of at-home consultations makes it much more likely that patients will complete all of their follow-up consultation sessions and get the best results from their bracing treatment. 

In the same study, 95% of the patients said they felt comfortable using remote consultations to treat their condition, while every patient interviewed said that all of their doubts and questions were answered using the telemedicine system. 

If given the option, less than 20% of patients said that they would prefer to switch back to in-person consultation. This indicates that most people preferred the flexibility and convenience of the remote consultation system. In many cases, the telemedicine clinic is able to work around the patient’s preferences and schedule consultation times which work best for them. 

People on a lower household income were the most interested in continuing telemedicine. This is likely due to the much cheaper doctor bills when using remote treatment. Each in-person doctor consultation may cost anywhere from $50 to $500, in addition to the travel costs to get to the nearest pectus clinic. In contrast, Dakota Brace offers free online consultations and regular follow-up sessions with our team of certified clinicians, all included in the up front price. Dakota Brace also offers financing plans of up to 12 months  all of these factors makes the treatment of pectus carinatum available for everyone. 

Furthermore, every step of the treatment process for pigeon chest can now be done from the comfort of your own home. After sending a scan kit through the mail, our team will remotely guide you to capture a 3D scan of your child’s chest, using an iPhone X or later model. After designing, manufacturing and shipping the brace, we schedule regular check-in sessions to check the fit and track your progress. This ensures you receive the best care possible and allows us to answer any questions you may have. 

Finally, the turnaround times for remote treatment of pectus carinatum are much quicker compared to in-person treatment. At Dakota Brace, we use the latest 3D printing technology to produce custom braces in just 5 business days. In contrast, you may have to wait up to 8 weeks for a custom brace to be manufactured using traditional methods. 

Conclusion

The use of orthotic bracing is now recommended as a first-line treatment for pectus carinatum. Furthermore, recent results have shown that remotely guided brace treatment is just as effective as in-person doctor consultations. Ready to restore your child’s health and confidence? Click here for your free consultation and get $75 off your first order, and get evaluated for either our Custom Pectus Brace (The Dakota Brace) or our Custom Pectus & Two Rib Flare Brace (The Bison Brace).

References

1. Hippocrates: Genuine Works (1849). Vol. 2. London, Sydenham Society. 
2. Kuru, P., Cakiroglu, A., Er, A., Ozbakir, H., Cinel, A. E., Cangut, B., ... & Yuksel, M. (2016). Pectus excavatum and pectus carinatum: associated conditions, family history, and postoperative patient satisfaction. The Korean Journal of Thoracic and Cardiovascular Surgery, 49(1), 29.
3. Moore, J., & Buckberry, J. (2016). The use of corsetry to treat Pott’s disease of the spine from 19th century Wolverhampton, England. International Journal of Paleopathology, 14, 74-80.
4. Ravitch, M. M. (1960). Operative correction of pectus carinatum (pigeon breast). Annals of Surgery, 151(5), 705.
5. Abramson, H. (2005). A minimally invasive technique to repair pectus carinatum. Preliminary report. Archivos de Bronconeumología ((English Edition)), 41(6), 349-351. 
6. Frey, A. S., Garcia, V. F., Brown, R. L., Inge, T. H., Ryckman, F. C., Cohen, A. P., ... & Azizkhan, R. G. (2006). Nonoperative management of pectus carinatum. Journal of Pediatric Surgery, 41(1), 40-45.
7. Lee, R. T., Moorman, S., Schneider, M., & Sigalet, D. L. (2013). Bracing is an effective therapy for pectus carinatum: interim results. Journal of Pediatric Surgery, 48(1), 184-190.
8. Colozza, S., & Bütter, A. (2013). Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. Journal of Pediatric Surgery, 48(5), 1055-1059.
9. Kang, D. Y., Jung, J., Chung, S., Cho, J., & Lee, S. (2014). Factors affecting patient compliance with compressive brace therapy for pectus carinatum. Interactive CardioVascular and Thoracic Surgery, 19(6), 900-903.
10. Gigena, C., Di Vincenzo, M., Toselli, L., Bellia-Munzon, G., Sanjurjo, D., Martinez, J., ... & Martinez-Ferro, M. (2021). Remote treatment of pectus carinatum (telepectus) during the COVID-19 pandemic. Journal of Pediatric Surgery, DOI: 10.1016/j.jpedsurg.2021.10.048.