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Surgeon simplifies chest surgery

By David Zisser

Oct. 13, 2002 9:00 p.m.

UCLA employee Tim Alexander was born with pectus excavatum, a
deformity also known as “sunken” or
“concave” chest.

Although he was initially advised against corrective surgery
when he was younger, Alexander, now 32 years old, was able to take
advantage of a new technique developed by UCLA professor of surgery
Eric Fonkulsrud.

“PE” is the most common congenital chest deformity,
occurring in about 1 in every 400 births. It is about seven times
more common than pectus carinatum, a protrusion of the chest.

When he was young, Alexander dreaded taking off his shirt during
sports or swimming. But other than some embarrassment, Alexander
had experienced no other problems that warranted surgery.

His pediatrician said the surgery would be “too
messy” and unnecessary.

So he lived with it. When Alexander was about 28 years old, he
started to experience chest pain, shortness of breath and fatigue
““ all common symptoms of PE.

He heard about Fonkulsrud through his mother, who worked as a
head nurse in the surgery department at the time.

Fonkulsrud, who is now 70 years old, had developed a new
technique for repairing PE and PC.

Since setting up a Web site about the surgery five years ago to
generate publicity about the procedure, Fonkulsrud has performed
between 70 and 100 of the procedures every year. Before that, he
was doing between 20 and 25 a year.

When Alexander first met with the doctor, Fonkulsrud told him it
was his decision whether or not to go ahead with the surgery.

“The way he described it, it sounded very simple,”
Alexander said.

After Fonkulsrud walked Alexander through exactly how the
surgery would work, Alexander felt comfortable enough to go through
with it.

“It wasn’t anything all that difficult. He made me
feel very comfortable,” he added. “I was ready to do
it.”

The three-hour surgical procedure involves partially removing
the cartilage that is pushed in or out (depending on whether it is
PE or PC) on each side of the lower chest. Most of the cartilage
and its covering, the periosteum, are carefully preserved.

The sternum is then elevated to the desired position and
supported by a thin metal bar attached to a rib on each side.

The periosteum eventually generates new cartilage and becomes
solid in the new, normal position within four to six weeks.

The technique is less invasive than others, causing less
bleeding during the surgery, according to Fonkulsrud.

The metal bar is then removed from the patient six months later.
In an outpatient, the procedure takes less than 30 minutes, and the
patient may participate in vigorous physical activity, even contact
sports.

Of the more than 750 procedures of this type that Fonkulsrud has
performed in his 35 years at UCLA, there have never been serious
complications.

Patients come from all over the country and the world to see
Fonkulsrud, including patients from Alaska, Australia, Canada,
Great Britain and Hungary.

Fonkulsrud started performing the surgery on adults like
Alexander eight years ago and has had over 150 patients at least 20
years old.

The ideal age is around adolescence, between the ages of 13 and
17.

The bones and cartilage are thicker in adolescent patients and
smaller and fragile in pre-adolescent patients, making the surgery
more difficult.

The surgery can be successful, however, with older patients. The
oldest patient Fonkulsrud has had was 55 years old, and a
68-year-old patient is scheduled to come in soon for the
surgery.

Like Alexander, most patients do not experience any serious
problems with PE until they are older. Many experience pain around
11 or 12 years of age, when they start to experience rapid
growth.

Two years after the surgery, Alexander is in good health.
Although he is used to how he looks now, at first it took some
getting used to.

“It was kind of weird actually,” he said.
“You’re so used to that indentation your whole life,
and all of a sudden it’s gone.”

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David Zisser
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