Preface

While reviewing the numerous changes that have occurred in our understanding and treatment of chest wall lesions, it is remarkable to reflect on what we have inherited from the century which recently closed. It is hard to believe that a mere 100 years ago chest wall surgery was essentially off limits to surgeons.

In this issue of Seminars in Pediatric Surgery, we present the latest advances and techniques in chest wall surgery and review the problems resolved by each generation of surgeons. Before the era of positive pressure ventilation, surgeons devised techniques that allowed them to “stay out of the chest cavity,” including the “open” repair of the pectus excavatum. The dramatic advances that occurred in the surgical field during the second half of the last century, including improved anesthesia, the use of muscle and tissue flaps, the use of a variety of rigid and absorbable materials for reconstructive procedures, and finally the introduction of fiberoptics which opened the door to minimally invasive techniques, have particularly impacted the treatment of chest wall lesions.

In this issue of Seminars, we have focused on problems that have recently undergone a change in management. Engum reviews the present understanding of the embryology of chest wall development, the causes of the congenital malformations, and their management. Advances in the management and reconstruction of congenital chest wall deficiencies are highlighted: Poland Syndrome by Moir and Johnson, the extremely challenging Jeune's Syndrome by Phillips, and the management and reconstruction of acquired chest wall lesions are reviewed by La Quaglia.

The anatomy and pathophysiology of chest wall deformities are better understood because of new imaging and physiologic testing tools, such as CT scanning and two-dimensional echocardiography. These developments are reviewed by Kelly.

In the latter part of the 20th century, there was a large paradigm shift from ever-larger operations to minimally invasive procedures. This shift is exemplified by the manuscript of Martinez–Ferro, Fraire, and Bernard, which reviews their highly successful experience with a nonoperative technique for the management of pectus carinatum, a condition which is especially common in their native Argentina. Drs. Fecteau and Nuss review the advances and modifications that have occurred in the last 20 years in the surgical techniques for the repair of pectus excavatum. The open technique has been significantly modified during the last 20 years. Timing of operation has changed, too—repair is rarely done in young children now. A full spectrum of operations is important because, although minimally invasive techniques may be advantageous, there will always be circumstances that require the open technique. The minimally invasive pectus repair has also undergone modifications since it was first introduced 10 years ago.