1. 6 Children’s Hospital of The King’s Daughters FALL 2015 7
Feature
Despite major surgery just four days earlier to implant four titanium plates in his chest,
Richard Cole was in good spirits with his mother, Karen Cole, and surgical technician Rachel
Dickens, nurseTonya Whitehurst and nurse Barbara L’Abbe who helped him recover.
WRITTEN BY Rich Radford
PHOTOGRAPH BY Rich-Joseph Facun/The Virginian-Pilot
B
y age 26, Richard Cole had almost given up hope that
anyone could fix his concave chest.
Richard, who lives in Smith Mountain Lake near Roanoke,
was born with pectus excavatum, also called sunken chest
syndrome. He had his first surgery to correct the condition at
age 5, at a military hospital. During that procedure, surgeons
removed cartilage in the area of the depression with the plan that
it would regenerate and support his chest in the correct position.
Unfortunately, the procedure failed, and his chest reverted to its
original concave (sunken) profile.
When Richard was 14, surgeons near his home at the time in
Northern Virginia assured him that they could do a better job
than the first group had. But their optimism faded quickly in the
operating room when they realized that the cartilage removed
from Richard’s chest at age 5 had never regenerated. Without
adequate scaffolding from ribs and cartilage to reshape the chest
wall, they were unable to perform the planned procedure.
Richard woke up bitterly disappointed.
As his chest grew, but his cartilage did not, Richard’s situation
became more dire. “You could see my heartbeat through my
skin,”he says.“If I had been in a car accident, the steering column
or even just an air bag would have caused enough blunt-force
trauma to kill me instantly.”
So, at age 20, Richard tried again. This time he turned to a
military surgeon with experience operating on soldiers who
sustained traumatic chest wall injuries in Afghanistan. The
surgeon implanted synthetic mesh between Richard’s heart
and sternum with the expectation that it would foster bone and
cartilage regeneration. Once again, the attempt failed.
ONE-OF-A-KIND
BREAKTHROUGH
Custom solution continues CHKD’s
leadership in chest wall reconstruction
2. for the titanium plates to rest upon. He then placed the
four plates together like a puzzle that meets in the middle
of Richard’s chest. Then Dr. Frantz attached the plates to the
remaining ribs using more than 70 screws. After the new
chest wall was in place, Dr. Franz stretched Richard’s pectoral
muscles across the top surface of the plates and closed
Richard’s incisions.
When Richard awoke after more than seven hours of
surgery, he immediately felt a difference. “I could breathe
for the first time in years … I couldn’t stop crying because
I was so happy. I was euphoric,” he says. By that evening,
with the help of his physical therapists, he was walking
through CHKD’s hallways.
In the days that followed, Dr. Frantz was cautiously
optimistic about Richard’s marked improvements in
breathing ability. “We had never attempted a repair this
extensive,” he says. “This is case No. 1, so we kept close tabs
on Richard as he recovered, and we were very pleased with
his progress.”
After a week at CHKD, Richard continued recovering at
his home in western Virginia and returned to the hospital
for a series of follow-up checkups. “Every time I see Richard,
my smile gets a little bit bigger in appreciation for what we
were able to do and how well Richard has adapted to his
new chest wall,”says Dr. Frantz.“He has a different perspective
on life. He can breathe much easier, and this has opened
a window to a much brighter future for him.”
Richard agrees.This fall, he returned to college in Cincinnati
to study theology and is encouraged about his future
opportunities and his newfound health. He started running
to rebuild his stamina and hopes to complete a 10-mile
run next year. “Today I am feeling like a brand new
person,”says Richard. “It is a very wonderful contrast to how
life used to be.”
8 Children’s Hospital of The King’s Daughters FALL 2015 9
Then, at age 26, Richard learned of one more place that
might offer him the hope of a more normal life: Children’s
Hospital of The King’s Daughters. “My little brother’s
pediatrician told me that CHKD did amazing things with
chest wall repair.”
CHKD became an international pacesetter in pediatric
chest wall repair when Dr. Donald Nuss created a minimally
invasive surgical approach to correct pectus excavatum
in the late 1980s. For 30 years, CHKD has been perfecting
the Nuss Procedure and leading international research
and innovation in the field of chest wall repair. Richard
read about CHKD’s expertise with his condition and made
an appointment with Dr. Frazier Frantz, one of CHKD’s
pediatric surgeons.
After an initial consultation, Dr. Frantz was motivated to
help the young man. “Richard was suffering. He essentially
had a condition called flail chest in which broken or absent
cartilage compromises normal breathing,” he says. “When a
person with flail chest takes a breath in, the sternum is sucked
inward and lung expansion is inhibited. Just the opposite
of what happens with normal respiration. Breathing in this
manner severely limits exercise capability and quality of
life. The condition also caused Richard chronic pain, which
further limited his activity.”
But absent adequate chest cartilage, Richard wasn’t a
candidate for any of the procedures in CHKD’s extensive
repertoire of chest reconstruction techniques, which are
all based on the pliable nature of the chest wall. “Richard
provided us with an opportunity to think outside the box,”
says Dr. Frantz.
To help Richard, Dr. Frantz and the CHKD chest wall team
envisioned something like the breastplate of a knight, which
could be surgically affixed to Richard’s remaining ribs. “The
goal was to restore stability and improve function,” he says.
“The chest has to be strong enough to protect his internal
organs and flexible enough to expand and contract.”
Dr. Frantz shared MRI images and CT scans of Richard’s
chest with engineers at Biomet Microfixation, the
manufacturer of the hardware used in the Nuss Procedure.
After months of planning, the engineers created four
titaniumplatesthatwouldbeattachedtoRichard’sremaining
sternum and ribs to create a strong but moveable chest wall.
In the groundbreaking surgery last April, Dr. Frantz began
by fracturing Richard’s sternum to create a smooth surface
A smiling Richard Cole returned to CHKD’s Center for Chest Wall Reconstruction a
month after surgery for a check-up with nurse Salena Holmes and Dr. Frazier Frantz.
Three-dimensional imaging was used to help CHKD surgeons and engineers at Biomet Microfixation design
four titanium implants to reconstruct Richard’s chest.Titanium is stronger and lighter than the stainless steel
used in many surgical implants. It is also less rigid, making the plates less stressful on existing bone structure.
“I could breathe for the
first time in years …
I couldn’t stop crying
because I was so happy.
I was euphoric.”
- Richard Cole
Dr. Frazier Frantz
Dr. Frazier Frantz practices with
CHKD Surgical Group’s
pediatric surgery practice.
For more information on CHKD’s chest wall
reconstruction program, visit CHKD.org/Nuss.
Before surgery
After surgery
