July 25, 2008 |
Dear Barry,

This is a very sad story, which certainly ruined several years of your life.

well indeed I started by an improved Ravitch developed in Germany called Hegemann Willlital and we did over 3600 of those,

then I turned to Nuss and so far we have done 696

then we developed minimal access carinatum repair, which is indeed a hybrid between Nuss and Hegemann Willlital and we did 113 of those

To answer your question I have treated 6 floating sternums mostly in PC patients, all referred to me (so it is very rare, 6 in nearly 4500 patients about 1 per 1000) , the most recent patient was Spanish and from Madrid another one from London,

and I used a combination of Nuss redo and our new PC operation — actually all could be stabilized permanently.

Basically I think your problem lies somewhere between the mechanics of PE and PC so I would most probably use a combination of both methods and maybe two types of bars simultaneously (you find in the attached papers) as I did with the recent cases - I am sure your chest can be stabilized — basically it's a question of experience in a multinational reference centre (for Europe and a bit beyond), since 1981 I have seen and repaired a lot, this June I have another Redo of a Foncalsrud patient from California and I had a few redos of Colombani's patients (instable fractured sternum).

For a first assessment please send digital photos (front and oblique from both sides would help) to give me an idea of what I will find now.

you will have do a few test before and bring and bring the results and pictures for the operation- most of which you probably have already:

blood tests particularly a large blood coagulation check as well as hepatitis-serology and HIV-serology

long time ECG, Echocardiogram, lung function test and a few CT slides through the deepest part of the funnel

And a skin allergy test against nickel and Chromium

A relative can come with you, you should plan 2 weeks in Germany,

work is possible 3-4 weeks after the repair sports 6-8 weeks after the repair

This redo-redo-redo-redo will not be cheap, it will amount to 22000 E (fixed price) payable 2 weeks in advance

I really want to help you and I don't think you will find more experienced centres,

If you can manage the financial issues, I might do you in early May or late July

Please your date of birth

Prof. Dr. Dr. Klaus Schaarschmidt,
Director of Helios Center for Pediatric & Adolescent Surgery, Berlin-Buch

© barry reinschreiber