The patient is a young male with a severe pectus excavatum. Despite visiting multiple hospitals, he has not received treatment due to the complexity of his deformity.

A severe depression is present in the center of the chest wall, with the right edge of the depression forming a ridge-like protrusion. Meanwhile, the edges and bottom of the depression have developed acute angle deformities.

We began by pre-shaping the depression to effectively release local stress and simplify the complex deformities. The Wung procedure and the Wang procedure were then simultaneously performed to correct the severe pectus excavatum and associated acute angle deformity. After the surgery, the chest wall deformity was completely resolved, and its appearance returned to normal.

What are Acute Angle Deformity and Pre-shaping?

Acute angle deformity refers to a specific type of localized deformity where a sharp angle forms in areas of significant protrusion or depression of the chest wall. This malformation does not exist independently but rather manifests as a feature within a diverse range of chest wall deformities, encompassing single deformity such as pectus excavatum and pectus carinatum, as well as various complex deformities.

Acute angle deformity is most commonly seen in cases where pectus excavatum surgery has failed. Due to the unreasonable placement of the bars during the operation, the original depression not only fails to disappear, but squeezed to one side of the chest wall, eventually forming acute-angle deformities at the base and one edge of the depression.

The defining characteristic of acute angle deformity is the extreme hardness and concentrated stress in the affected bones. Attempting to correct the deformity directly with bars can lead to numerous complications, such as fractures, alteration or even breakage of the bars. These issues not only significantly affect the correction results but also directly lead to surgical failure and various complications.

To better correct chest wall deformities, especially acute angle deformity, the concept of pre-shaping was developed. Pre-shaping involves using various methods and tools to apply external force to the deformed region, adjusting the bone structure to a more normal appearance. For instance, during pectus excavatum surgery, the depressed bone structure is first lifted with a surgical retractor before inserting a bar to support it. This approach significantly reduces the difficulty and risks of bar shaping, leading to more effective surgical outcomes.

Illustration of Acute Angle Deformity