Compound Thoracic Deformity，After Cardiac Surgery，Wenlin Procedure，By Dr. Wang。

The patient was a three year old boy，病人是3岁男孩。

He was diagnosed with congental ventricular septal defect，出生后被诊断为先天性室间隔缺损。

shortly after birth，一岁时接受心脏手术。

and he underwent heart surgery，术中用正中胸骨切口。

at age of one. The median sternotomy was used in operation，术后。

the median part of the anterior chest was gradually protruded whereas bilateral parts of the chest wall are depressed，前胸壁胸部逐渐凸起，两侧胸壁凹陷。

The deformity worsened with age，畸形随年龄加重。

In order to correct the deformity，为治疗畸形。

the child was admitted to our hospital at age 3，3岁入我院。

Physical examination showed there was a surgical scar，体检可见正中。

on the anterior chest wall，疤痕。

the median part was protrusive and both lateral parts，凸起，两侧。

were obviously depressed，明显凹陷。

No heart murmur was heard by auscultation，未闻及心脏杂音。

Imaging examination showed that，影像学检查提示。

the anterior chest wall was protrusive in the middle，前胸壁正中凸起。

with acute angle disformity，呈锐角畸形。

on top of the protrusion，在凸起顶部。

and lateral chest wall depressed on both sides，两侧胸壁凹陷。

Echocardiography showed that the ventricular septum，超声显示室间隔。

was integral without residual defect，完整，没有残余缺损。

The patient was diagnosed with secondary severe，病人术前诊断为继发性重度。

compound thoracic deformity before operation，复合型胸壁畸形。

After full preparation，充分准备后全麻下手术。

two切口分别位于两侧胸壁，长2CM，使用Wenlin手术矫正。手术一帆风顺，没有并发症，术后畸形消失。随访一年，胸壁外观基本正常，无明显畸形。心脏手术常经正中胸骨切口完成，术后胸骨如果固定不牢固可导致继发性畸形。

术后最常见的畸形是鸡胸，较为少见的是漏斗胸，复合型畸形未见报道。此患儿畸形特殊，前胸壁凸起严重，呈锐角畸形，两侧胸壁有对称性凹陷，这种畸形不能使用一般三明治技术。我们为他用了Wenlin手术，术中凸起被钢板中间压平。并将其固定在钢板上，这样可以使凹陷消除。

从手术原理看，Wenlin手术是模板塑形手术，可以同时针对不同，包括凸起和凹陷。