Synthes VEPTR Quick start guide

VEPTR – Vertical Expandable
Prosthetic Titanium Rib. A new
treatment concept for paediatric
three-dimensional thoracic deformities.
Technique Guide

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Please note that specialised training is mandatory.
In order to perform procedures associated with the VEPTR
system, a wide range of additional basic spine surgery
instruments are required. For further details contact your
local Synthes representative.
Table of Contents
Image intensifier control
Treatment Concept 3
Indications 4
Contraindications 5
Construct Options 6
Implants 10
Instruments 15
Overview Surgical Technique 19
Primary Procedure 20
Expansion Procedure 38
Replacement Procedure 40
Introduction
Product Information
Surgical Technique

2Synthes VEPTR Technique Guide

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VEPTR – Vertical Expandable
Prosthetic Titanium Rib. A new
treatment concept for paediatric
three-dimensional thoracic deformities.
Concept
Three-dimensional thoracic approach to
treat patients with complex chest wall
and/or spinal deformities where the
thorax is unable to support normal res-
piration or lung growth (Thoracic Insuf-
ficiency Syndrome).
Designed to mechanically stabilize and
distract the thorax to improve respira-
tion and lung growth in infantile and
juvenile patients.
VEPTR devices control and may correct
scoliosis.
Devices are attached perpendicularly to
the patient’s natural ribs (superior at-
tachment point) and to more caudal
ribs, a lumbar vertebra or to the ilium
(inferior attachment point). This is done
through a standard thoracotomy inci-
sion by performing an opening wedge
thoracostomy.
Regular expansion, anatomic distrac-
tion, and replacement of components
through less invasive surgery.
Goals of treatment:
– Increase thoracic volume
– Scoliosis correction
– Thoracic symmetry by lengthening
the concave, restricted hemithorax
– Improve thoracic function
– Avoiding growth inhibition proce-
dures
– Maintain these improvements
throughout the growth of the child

4Synthes VEPTR Technique Guide
Indications
Primary Thoracic Insufficiency Syndrome (TIS) due to three-
dimensional deformity of the thorax
– Progressive thoracic congenital scoliosis with concave
fused ribs
– Progressive thoracic congenital scoliosis with flail chest due
to absent ribs
– Progressive thoracic congenital, neurogenic or idiopathic
scoliosis without rib abnormality
– Hypoplastic thorax syndromes
– Jeune’s Syndrome
– Jarcho-Levine Syndrome
– Cerebro costal mandibular syndrome
– Others
– Congenital chest wall defect, posterolateral
– Acquired chest wall defect, posterolateral
– Chest wall tumor resection
– Traumatic flail chest
– Surgical separation of conjoined twins
Secondary Thoracic Insufficiency due to lumbar kyphosis
(non gibbus)

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Contraindications
The VEPTR device should not be used under the following
conditions:
– Inadequate strength of bone (ribs/spine) for attachment of
the VEPTR
– Absence of proximal and distal ribs for attachment of the
VEPTR
– Absent diaphragmatic function
– Inadequate soft tissue for coverage of the VEPTR
– Age beyond skeletal maturity for use of the VEPTR
– Age below 6 months
– Known allergy to any of the device materials
– Infection at the operative site
Warnings and precautions
Patients implanted with the VEPTR should not be braced. The
VEPTR device is designed to allow for thoracic cavity growth
and the restrictive nature of a brace would not help the con-
dition, but defeat its purpose.
Patients may require additional wound protection to prevent
inadvertent rubbing or bumping of the wound.
Patients with a diagnosis of spina bifida should have an oc-
clusive dressing over the wound site to keep the site dry.

6Synthes VEPTR Technique Guide
Construct Options
The VEPTR set contains 220 mm and 70 mm radius
constructs.
220 mm radius constructs are used to treat most of the
VEPTR indications and are the standard VEPTR constructs.

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70 mm radius constructs are used to treat hypoplastic
thorax syndromes.
A hypoplastic low thorax volume (as seen with Jeune’s Syn-
drome) requires the use of a 70 mm rib-to-rib construct
(70 mm implants include: Cranial Rib Support, Caudal Rib
Support, Extension Bar). These constructs are placed bilater-
ally in separate procedures.
Surgical technique for 70 mm radius constructs
After inserting both the Cranial and Caudal Rib Support, free
the central segment of the selected hemithorax by making
transverse incisions in the periosteum to enable anterior and
posterior osteotomies.
Perform anterior and posterior osteotomies from ribs three
through eight. Distract the mobilized chest segment postero-
laterally.
Place retractors subperiosteally to protect the underlying
lung.
Choose 2–3 sites in the central portion of the mobilized seg-
ment to insert the 2.0 mm Titanium Rod which will hold
the ribs to the construct. Bend the rod to form a gentle curve
using the Wire Bending Pliers.
Assemble the construct as stated in the rib-to-rib construct
section.
After the construct has been completely assembled and
locked, use the Pliers to again grasp rods and contour
around implanted rib-to-rib construct, leaving space to re-
move the locks and expand the construct.

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Construct Options
Rib-to-lumbar lamina
– Attaches to rib and to lumbar spine
– Components available in 220 mm radius
1 Cranial Rib Support
2 Closing Half-Ring
3 Lock for Rib Support
4 Lumbar Extension Rod
5 Extension Bar
6 Closure for Extension Bar
7 Lamina Hook
Rib-to-ilium
– Attaches from rib to ilium
– Components available in 220 mm radius
1 Cranial Rib Support
2 Closing Half-Ring
3 Lock for Rib Support
4 Lumbar Extension Rod
5 Extension Bar
6 Closure for Extension Bar
7 Extension connector
8 Ala Hook
8Synthes VEPTR Technique Guide