D. Dean Potter Jr., M.D., uses a novel technique during a pectus excavatum procedure by securing a Nuss bar with a surgical zip tie. This lessens the migration of the thoracic strut, a common postoperative complication of the Nuss procedure.
modifications using stabilizers, multiple bars and additional fixation sutures have reduced the incidence of migration but has not totally eliminated bar migration. This is an uncut video demonstrating placement of the zip tie. Once the thoracic strut has been positioned, we identified the best rib for fixation. We prefer the zip tie to be positioned near the eye of the news bar. In this particular patient, the ports site used during cryotherapy was well positioned as the coddle exit site for the zip tie. As the zip tie has a blunt tip needle creating an exit thoracotomy. Makes passing the tie around the rib much easier. A needle driver is positioned in preparation to grasp the needle. Intra thoracic lee, the entry site cephalopod to the selected rib is identified again near the eye of the bar and the tie is placed under thor Kas ka pik visualization. The needle is large and blunt, which requires a bit of force to puncture the intercostal muscle. The needle is then grasped with the coddle needle. Driver and the needle is withdrawn from the chest. This maneuver simplifies placement due to the heavy gauge needle. Once the needle tip is extra thoracic placement is aided by pushing from the back of the needle and pulling from the tip with the needle driver. Once the zip tie is passed around the rib, the needle is removed with cable cutters, the tie is assembled as a standard zip tie, the tie is tightened using the manufacturer's tension. Er This device limits how tight the zip tie can be tension per the manufacturer's recommendations. This device also cuts the excess tie flush with the locking tie head. For demonstration purposes. The bar is tested using a clamp. The bar is well fixed to the rib and is quite stable. The procedure is then completed per routine.
