General, Minimally Invasive & Thoracic Surgery

Instructions For The Patient After Pectus Bar Placement
For Repair Of Pectus Excavatum

This information will help you care for the patient at home.  Please also refer to your Nursing Discharge Information Instructions for additional information, including medication dosing and date of your follow up appointment.

INCISION CARE

• The primary dressings (gauze covered with clear Tegaderm) will be removed three days after surgery.  The paper tape (Steri-strips) covering the incision sites will fall off on their own over the first 1-3 weeks. 
• Please call our office if the patient develops fever of 101 or greater, or if you note increasing redness, swelling, or drainage from the incision sites. 

SHOWERING:

• The patient may shower with the Steri-strips in place.   Once the Steri-Strips have fallen off you may clean the incision sites with soap and water. 
• The patient may take a tub bath 1 week after the procedure

ACTIVITY:

• The patient may gradually increase physical activity as tolerated using good judgment.  The patient should be up, dressed and moving each day.  Walking is excellent exercise and will help to build your patient’s strength.
• No twisting for the first four weeks at home.  The patient must avoid contact sports, strenuous activities, rotational sports (like baseball, tennis, hockey, and golf), and heavy lifting (nothing over 5-10 pounds) for 12 weeks following surgery.   It is a good  idea to have a set of school textbooks at home, as well as one at school to avoid carrying heavy backpacks for this time also. 
• Patients are typically out of school for 2-3 weeks, but may return to school sooner if he/she feels well enough,
• The patient is strongly encouraged to wear the Figure 8 brace whenever they are out of bed and active for the first 6-8 weeks.
• It is normal for the patient to be fatigued after discharge, but it is important to take deep breaths and to walk to expand the lungs.  Deep-breathing activities should be performed at least twice daily.  Please call the office immediately if the patient develops shortness of breath or difficulty breathing.
• Young adults may not drive while taking pain medication or if they cannot move freely because of pain or discomfort.

DIET:

• The patient can resume a regular diet.  If the patient experiences constipation while taking the prescription pain medications, increase the intake of fluids and high fiber foods.  The patient may also need to take a stool softener such as Colace.
• If vomiting occurs, do not eat or drink for 2 hours.   Then try small amounts of clear liquids or half strength juice until the patient does not vomit any more. Then slowly start a normal diet.  If the patient continues to vomit please call the office.

PAIN:

• The patient will have a prescription for pain medication.  If the incisions remain uncomfortable use the prescription medication according to instructions.  Please take these medications with food if you experience nausea or vomiting.
• Some patients experience more pain at night and in the morning when they wake up as they become active.  Often patients find it more comfortable to sleep in a semi-upright position, such as in a recliner.
• Your may take Tylenol® (acetaminophen) or Motrin® (ibuprofen) for discomfort if the pain is mild.

OTHER:

• The implant will remain in place for a minimum of 2 years.  Should you require emergency medical attention during this period, the following recommendations will apply:
• A MedicAlert identification is recommended and can be ordered at most pharmacies or may be ordered online at www.Medicalert.org.  The inscription on the bracelet should read “Surgical steel bar in place under sternum”. 
• If the patient needs to have a MRI of the chest or abdomen, they may have the study without restriction.  However, they may experience some warmth of discomfort at the site of the pectus bar during the imaging.
• Cardiac defibrillation, if necessary, is performed with anterior/posterior paddle placement to deliver electrical charge to the heart. The patient may require more external force.
• The patient may activate metal alarm systems, particularly hand held wands that are used in airports.  The patient will be given written documentation that a surgical steel bar has been placed and is not palpable.

These instructions are provided as a basic post-operative guideline.  Please call to speak with your Pediatric Surgeon or the nurse practitioner if you have any questions or concerns.