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Postoperative Care and Exercise

Although classified as a minimally-invasive surgery, the nuss procedure is a complex surgery and the post-operative care should be dealt with extreme caution and care. The recovery process is slow and the patient is limited in number of areas in the upcoming months. It is highly recommendable for patients who undergo surgical repair for pectus excavatum to have a medical professional to help them with the care afterwards, or at least, some close family member to assist them with everyday tasks. The patient is faced with many restrictions in everyday life, ranging from limited movement, object lifting, up to falling asleep in normal positions.

Recovery

  • Strict bedrest up to 3 days – Depending on the difficulty of the surgery and how many bars have been implanted, the patient is obligated to remain fixed and stationary for one to tree days after the surgery. This will prevent dislocation of the bars caused by any movement. After the initial period, the patient will begin light physical therapy, mainly trying to stand up and make his first steps.
  • Small walking sessions – After the initial hospital stay (average period is 5 – 9 days, depending on the surgery), the patient is encouraged to start with everyday walking sessions. The walks can be as little as 10 minutes, 2 -3 times a day, it is more important for the body to start adjusting to the foreign object. As the body starts adjusting more and more, the walks and level of physical activity should be increased respectably.
  • Breathing exercises – this is the most important recovery process and should start on the same day when the patient is released from hospital. Breathing exercises are extremely important because they exercise and loosen the ligaments around the sternum, area that is damaged during the surgery. Also, we know that limited lung capacity is a pectus excavatum side effect so this can also be seen as the first step to fulfilling full lung capacity. Most practical and medically approved breathing instrument for nuss recovery are the spirometer and acapella devices.
  • No lifting objects heavier than 5 pound for 6 weeks – after the surgery the body is in weak state and lifting objects is not only extremely difficult but also not recommended, as the pectus bar needs time to fully stabilize and adjust to the body. Patients should also avoid puling themselves up from bed, lifting their arms above their head or sleep on their chest for the first 6 weeks.
  • No sports or serious activity up to 3 months – although there are cases when patients have started bodybuilding exercises or some light contact sport prior to the 3 mark period, these are rare exceptions and are not recommended when recovering from the nuss procedure. The chest area is still very fragile and some minor contact or applied pressure could dislocate the bar.
  • Cardio workout after 3 month period  – after the initial 3 months cardio workouts are recommended by doctors as it helps with the recovery and strengthens the chest area. Exercises such as swimming, running or biking are hugely encouraged.

The pain experienced after the Nuss procedure should not be underestimated. The body has undergone a massive change in just 2 hours and the healing process is slow and painfull. For the pain right after the surgery, surgeons use Pain Controlled Analgesia (PCA) pump, so the patients can request pain relief through a button whenever he or she feels is needed. After the patient is released from hospital he will receive prescription for adequate pain medications.

 

Post-op exercise

After having the nuss procedure, the patient will not be able to do proper physical exercise for 3 months. In fact, for the first few weeks, not even objects heavier than 5 pounds are recommended to be lifted. This is because the sternum and the muscles supporting him are in very fragile state and need time to heal properly.

But these does not apply to all types of exercise. Breathing exercises are recommended even on the first day after the surgery.  This is because of the “rearrangement” in the torso area, there is now space left that was previously denied by the sunken sternum. This space is reserved for the expansion of the lungs, so working the lungs from day one is recommended by surgeons and physician. Ideally, running and swimming would be a great fit for this kind of cardiovascular exercise, but as the patients are restricted in their activities for the initial period, an incentive spirometer is the most widely used instrument. 

 

Breathing device for after pectus excavatum surgery

Most common used device for breathing exercises after surgery


Recommended use for the inspirometer after surgery:  

  • Standing up straight, take and place the inspirometer in upright position. Slowly exhale (breath out) to your maximum, then put the instrument in your mouth and close it. Try not to block the mouthpiece with your tongue.
  • Start inhaling slowly and deeply through the mouthpiece, trying to raise the indicator. After you finish, hold your breath for 3 seconds and mark your position.
  • Exhale and repeat.
  • Repeat these steps 10 times every 3 hours for the first week. As you progress in your breathing patterns, you can reduce the repeating steps.
  • Mark your progress every day and try to beat it.
  • Recommended for the first two months after surgery. After that the patient should be able to run or exercise.

Using this or other easy breathing techniques after surgery is recommended by all the surgeons. Expanding your lungs and filling up the new open space is the first thing we need to start working on, to reduces the chances of regression. Besides that, breathing exercises push the sternum forward and doing this exercises regularly right after surgery, will try and hold the sternum in his new position.

 

 

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Possible Complications After The Operation

  • Pneumothorax – acumulation of air between the lungs and the inside of the chest wall area. This has been reported in only 2% of the patients and is easily dealt with a chest drain.
  • Pleural Effusion – same as the pneumothorax, just instead of air, fluid gets stuck between the lungs and the inside of the chest area. It is also treatable with chest drain.
  • Infections – this can be easily recognisable as the scars start getting red, sore or oozing.
  • Increased temperature – this is very rare and if it happens it could point to another complication, such as infection or pleural effusion.
  • Bar displacement – this is by far the most important thing because if the bar is displaced, then a new surgery is required in order to position the bar properly. Luckily this is avoidable by limiting the physical activities for the first 3 months until the bar is firmly adjusted.