New Bracing System Dramatically Reduces Treatment Time for Pectus Carinatum
This year, Cincinnati Children's became one of the first pediatric hospitals in the country to offer the FMF Dynamic Compressor System for patients with pectus carinatum. The bracing system provides objective measures of a child’s chest wall deformity, and calculates how much pressure is needed for correction. Children with mild to moderate pectus carinatum wear the brace for two to eight months, compared to 24 months or more with less advanced systems.
The FMF Dynamic Compressor is custom manufactured to each child’s measurements, and adjustable to any thoracic shape or size. It is made of lightweight aluminum and has a low profile, an improvement over previous braces. The brace is manufactured in Argentina, where the incidence of pectus carinatum is much higher than in the United States.
Last year Rebeccah Brown, MD, FACS, FAAP, co-director of the Chest Wall Deformity Center at Cincinnati Children’s, traveled to Argentina with one of the center’s nurses to see the brace used in a clinical setting. “We observed about 20 patients in various stages of treatment, and were very impressed by what we saw in terms of overall patient satisfaction and clinical outcomes,” says Brown. “Because this brace is more comfortable and shortens treatment time, we expect to see an improvement in compliance, which is often an issue for children who wear a brace for pectus carinatum.”
A more scientific approach With previous bracing systems, patients were fitted with a brace and wore it “as tightly as they could, as often as they could, 24 hours a day, seven days a week,” Brown says. They would return to the clinic every three months for an evaluation. The physician would look at photos of the patient from the previous visit to assess progress and decide whether more brace time was needed.
The FMF Dynamic Compressor System provides a more scientific approach. When the patient is initially evaluated, a device is used to measure the pressure required to correct the protrusion (the pressure of correction). Based on this data, an algorithm calculates what pressure settings (in pounds per square inch) are needed in order to achieve correction, and provides an estimated length of treatment. Patients are classified into one of four groups – those with a mild deformity are in Group 1, and wear the brace around the clock for about two months. Those with a severe deformity (Group 4) wear it three to six hours a day for one to two years.
A compression plate rests against the protrusion when the brace is being worn, and has a docking station for a device that measures the pressure being delivered to the patient (the pressure of treatment). As a result, the brace can easily be adjusted to deliver the exact pressure of treatment. Patients return to the Chest Wall Deformity Center monthly, where the physician evaluates progress and adjusts pressure settings as needed. When the chest wall achieves a normal shape, the patient goes into “maintenance,” wearing it for short periods of time for two to six more months.
Patient Classifications for the FMF Dynamic Compressor System
Group 1 | Group 2 | Group 3 | Group 4 | |
Recommended hours of daily brace wear | 24 | 12-24 | 6-12 (day or night) | 3-6 (day or night) |
Estimated time to correction | 2-4 months | 4-8 months | 8-12 months | 1-2 years |
High success rate The success rate for the FMF Dynamic Compressor is about 90 percent when children wear the brace as directed. If the brace does not correct the defect, surgery is still an option. However, this is very rare.
“We will follow our patients closely to track outcomes,” Brown says. “But based on what we are seeing already, we expect the Dynamic Compressor to become our gold standard for treating pectus carinatum.”
To learn more or refer a patient for a pectus evaluation, call 513-803-1062 or email chest-wall-center@cchmc.org.
