Chest wall bracing for children and young people with pectus carinatum

The evidence base for chest wall bracing in people with pectus carinatum consists largely of lower-level observational studies (case series). These studies consistently report that chest wall bracing in people with pectus carinatum is a safe, and clinically effective alternative to surgery, which is acceptable to most patients. Some people may still require surgery if, for example, chest wall bracing fails or is not appropriate in practice.

The evidence base is heterogeneous, particularly with regard to the bracing protocol used (including wear time and duration of treatment), the selection of patients and how clinical outcomes are measured.

People with pectus carinatum may have reduced self-esteem and body image. Successful treatment is associated with improved patient outcomes such as body image and quality of life

Accurate selection of patients based on age, pressure of initial correction and motivation appears to be important. High attrition rates were reported in several studies, where the treatment was abandoned for reasons including skin issues, discomfort, lack of motivation, slow/no improvement in the pectus carinatum and lengthy treatment durations. Protocols may be improved by addressing pain reduction, skin problems and discomfort. Family support was also associated with improved adherence. Rapid or immediate improvements in the pectus carinatum may increase patient motivation to continue with treatment.

The existing literature suggests that patients are suitable for dynamic chest wall bracing if the pressure of initial correction does not exceed 7.5 to 10 pounds per square inch (PSI). The literature also suggests that, to avoid skin ulcerations, the pressure of treatment should not exceed 2.5 to 3 PSI.