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Physician Update - Re-repairing a broken chest

Physician Update Summer 2011

Re-repairing a broken chest

Date: July 1, 2011

Among Stephen Yang’s specialties is chest reconstruction after major trauma or surgery.

When the 58-year-old Virginia equestrienne was brought into the local emergency room with chest and spine fractures from a riding accident, physicians focused on repositioning her broken bones just so she could mend.

Their quick work on her sternum did what it was supposed to do, but the healing process came with a certain price. The woman’s sternum buckled back at one level and forward at another level, producing an alarming midchest protrusion that jutted outward, as one physician described it, “like a third breast.”

The disfigurement itself took an emotional toll, but it also saddled the patient with chronic pain. For months, she’d sought relief in pain medicine and pain clinics without success. Then one physician, surmising that the source of the woman’s pain might be anchored in her misshapen sternum, referred her to Stephen Yang, head of Johns Hopkins’ thoracic surgery division.

When the patient visited him a year ago, Yang recognized that her sternum’s condition resembled the relatively common congenital deformity pectus excavatum,  which found its first surgical solutions in the care of the late Johns Hopkins surgeon Mark Ravitch. But what really struck Yang was that this case stemmed from a traumatic injury, and he agreed that it was the source of the patient’s chronic pain. He also agreed to operate.

A seasoned thoracic expert known for a growing string of successful lung cancer surgeries, Yang has lately been blending ideas from other surgical traditions. As with the patient at hand, patients might be dealing with cosmetic issues from an obvious deformity, the realm of plastic surgeons. But patients might also suffer from pain or functional deficits because of an injury to their chest wall, and that’s unquestionably Yang’s area.

“It’s like a mix of plastics, orthopedics and thoracic,” says Yang, “but it’s also basic chest wall reconstruction.”

In a three-hour procedure with his injured equestrienne, Yang proceeded to “rebreak the bone, clean it up, smooth it out and reset it according to its natural contours.”

For the patient, all of the surgical disciplines came together for a perfect solution. “She’s literally back in the saddle,” Yang says. “She’s so happy, and I’m happy that she’s riding again.”  

410-933-1233 to refer a patient.

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