Monday, August 8, 2016

The Nuss Procedure and Dr. Donald Nuss

People generally search for rib flare or the nuss procedure after they've understood more about pectus excavatum, but many are unaware about who invented the Nuss Procedure.
Image of Dr. Donald Nuss

The Nuss Procedure was invented by Donald Nuss in 1986 as a more efficient and non-invasive surgery, essentially replacing the Ravitch Procedure and its modifications, which dominated the field for pectus excavatum surgeries. The Ravitch Procedure required the removal of skin and some muscles of the chest to access the rib cage cartilage (the Ravitch Procedure is actually a modification of the first Pectus Excavatum surgery committed by Ferdinand Sauerbruch). The biggest revolutionary act were small incisions on the rib cage to allow a metal bar to be inserted and turned 180 degrees to press the chest further (which was suggested in earlier attempts and in modifications of the Ravitch Procedure), thus not needing to further damage the chest in order to complete the surgery.
German Surgeon | Ferdinand Sauerbruch

The Nuss Procedure was a major modification, but influenced by earlier surgeons who also believed that cutting too much muscle or cartilage was inefficient. Some earlier surgeons committed the surgery on very young children, but later on, years before the Nuss Procedure was developed by Nuss, surgeons overwhelmingly agreed to wait for surgery until after puberty.