Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a device that is used for conditions of the spine and chest wall that interfere with growth and normal function.
Originally developed by Campbell and Smith in San Antonio, the device was FDA-approved in 2004 as a Humanitarian Device Exemption (HDE).
Children's Mercy has been using the device since early 2006 when Dr. Campbell helped to launch the VEPTR program. Synthes Corporation manufactures it and its use is monitored within the purview of the Institutional Review Board.
Currently we manage more than dozens of patients with this condition.
The current diagnoses for which VEPTR is used include:
Thoracic Insufficiency Syndrome is present when the thorax (ribs, spine and muscles and tissues that hold it together) is unable to support normal respiration and normal lung growth. To make the diagnosis of TIS, a history and physical with chest and spine x-rays, often a CT scan and pulmonary tests are done.
At Children's Mercy, we assess the potential VEPTR patient in a multi-disciplinary way. A pediatric pulmonologist and often a pediatric surgeon will see and assess the patient and help to determine whether the patient may be helped by VEPTR.
This typically involves an inpatient stay of a few days to a week. On several occasions pre-operatively the VEPTR team will review the patient's status and discuss the nature of the surgery. There are many different techniques possible with VEPTR including rib-to-rib, rib-to-spine and rib-to-pelvis options.
There is initially a short stay in the ICU. We have found that most patients do not routinely require a long stay in the ICU; most are weaned from the ventilator overnight. Some patients, who require more extensive chest wall surgery, will also require more breathing support. This may lead to several days on a ventilator.
Post-operatively, most patients go home on oral pain medications. Follow-up x-rays are typically taken within a week of discharge and typically at a six-week follow-up. At six-to-12 monthly intervals, the VEPTR device is lengthened. Initially, the patient may stay overnight but with familiarity of the patient and family, and with approval of the surgeon, often the lengthening can be done as an outpatient.