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Wang L, Yan X, Li J, Zhao J, Wang J, Yang S, Li D, Shi C, Li S, Wang J, Jiang T, Huang L. Outcomes following the excision of sarcoma and chest wall reconstruction using 3D printed implant. iScience 2024; 27:108757. [PMID: 38313046 PMCID: PMC10835347 DOI: 10.1016/j.isci.2023.108757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/14/2023] [Accepted: 12/13/2023] [Indexed: 02/06/2024] Open
Abstract
The survival outcomes of patients with chest wall sarcomas (CWS) were evaluated after receiving wide excision and chest wall reconstruction by using three-dimensional printed (3DP) implants. The survival outcomes evaluating the effect of 3DP implants for chest wall reconstruction is lacking. Here, forty-nine patients with CWS underwent radical wide excision and chest wall reconstruction using 3DP implants. The surgical data and long-term survival outcomes were collected and analyzed. With a median follow-up of 36 months, the disease-free survival (DFS) and overall survival (OS) were 31.7% and 58.5%, respectively. In addition, the 3-year DFS and OS can be significantly differentiated using the classification criteria of tumor grade, tumor size tumor area. Hence, wide excision and chest wall reconstruction using three-dimensional printed implants are a safe and effective treatment for chest wall sarcoma. The novel classification criteria of tumor size and area have the potential to predict the prognosis of CWS.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jing Li
- Department of Plastic and Burn Surgery, Tangdu Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jian Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Sanhu Yang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710049, Shaanxi, China
| | - Changquan Shi
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710049, Shaanxi, China
| | - Shaomin Li
- Department of Thoracic Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Junqi Wang
- Department of Thoracic Surgery, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Lijun Huang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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2
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Girotti PNC, Bianchi F. Chest wall reconstruction, prosthesis and allografts: a narrative review. J Thorac Dis 2023; 15:7077-7087. [PMID: 38249910 PMCID: PMC10797370 DOI: 10.21037/jtd-23-650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
Background and Objective What is the best material in the case of prosthesis used to replace major chest wall resection is still unknown. We reviewed most significant literature focused on the type of prosthetic materials available by highlighting their relative pros and cons. Methods We reviewed most significant articles, including clinical results of relevant case series (retrospective studies), published in English in the last 23 years: PubMed, Embase and Scopus databases were used in our search in the period between the 1st January 1999 and 31st December 2022. Key Content and Findings Overall, our literature review revealed lack of uniformity or conformity in the surgical strategies described for chest wall reconstruction with no internationally accepted standard in terms of decisions and optimal prosthetic materials and type of prostheses (soft, rigid, biological). Despite the increased interest in chest wall reconstruction, we observed a general lack of substantial prospective and multicentric studies. Likewise, there are not substantial data which may guide to the choice of optimal prosthetics in terms of characteristics and biocompatibility. Conclusions A variety of materials are available for reconstruction, including synthetic and biological meshes, flexible and rigid patches, and metal osteosynthesis systems. The material chosen should be optimized to each patient and damaged tissues to be restored. Prospective and multicentric studies are necessary to address current limits in this surgical field.
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Affiliation(s)
| | - Fabrizio Bianchi
- Unit of Cancer Biomarkers, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
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Lonnee PW, Ovadja ZN, Hulsker CCC, van de Sande MAJ, van de Ven CP, Paes EC. Reconstructive Strategies in Pediatric Patients after Oncological Chest Wall Resection: A Systematic Review. Eur J Pediatr Surg 2023; 33:431-440. [PMID: 36640758 DOI: 10.1055/a-2013-3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. The aim of this study was to provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients less than 18 years old. A systematic literature search of the complete available literature was performed and results were analyzed. A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of nonautologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]), or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.
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Affiliation(s)
- Pieter W Lonnee
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Zachri N Ovadja
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - Emma C Paes
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
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Pontiki AA, Rhode K, Lampridis S, Bille A. Three-Dimensional Printing Applications in Thoracic Surgery. Thorac Surg Clin 2023; 33:273-281. [PMID: 37414483 DOI: 10.1016/j.thorsurg.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Advances in technology allowing the combination of medical imaging and three-dimensional printing have greatly benefitted thoracic surgery, allowing for the creation of complex prostheses. Surgical education is also a significant application of three-dimensional printing, especially for the development of simulation-based training models. Aiming to show how three-dimensional printing can benefit patients and clinicians in thoracic surgery, an optimized method to create patient-specific chest wall prosthesis using three-dimensional printing was developed and clinically validated. An artificial chest simulator for surgical training was also developed, replicating the human anatomy with high realism and accurately simulating a minimally invasive lobectomy.
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Affiliation(s)
- Antonia A Pontiki
- School of Biomedical Engineering and Imaging Sciences, King's College London; Department of Surgical & Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, St Thomas' Hospital, 4th Floor, Lambeth Wing, London SE1 7EU, UK. https://twitter.com/AntoniaPontiki
| | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London; Department of Surgical & Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, St Thomas' Hospital, 4th Floor, Lambeth Wing, London SE1 7EU, UK. https://twitter.com/KawalRhode
| | - Savvas Lampridis
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. https://twitter.com/SavvasLampridis
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; School of Cancer & Pharmaceutical Sciences, King's College London.
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5
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Young JS, McAllister M, Marshall MB. Three-dimensional technologies in chest wall resection and reconstruction. J Surg Oncol 2023; 127:336-342. [PMID: 36630098 DOI: 10.1002/jso.27164] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 01/12/2023]
Abstract
Resection and reconstruction of the chest wall can pose unique challenges given its vital role in the protection of the thoracic viscera and the dynamic part it plays in respiration. A number of new three-dimensional (3D) technologies may be invaluable in tackling these challenges. Herein we review the use of 3D technologies in preoperative imaging with virtual 3D models, printing of 3D models for preoperative planning, and printing of 3D prostheses when approaching complex chest wall reconstruction.
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Affiliation(s)
- John S Young
- Division of Thoracic and Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Thoracic Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Miles McAllister
- Division of Thoracic and Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Blair Marshall
- Division of Thoracic and Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Asanuma K, Tsujii M, Hagi T, Nakamura T, Kita K, Shimamoto A, Kataoka T, Takao M, Sudo A. Full-thickness chest wall resection for malignant chest wall tumors and postoperative problems. Front Oncol 2023; 13:1104536. [PMID: 37152065 PMCID: PMC10160664 DOI: 10.3389/fonc.2023.1104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Background Chest wall malignant tumor (including primary and metastatic lesions) is rare, representing less than 5% of all thoracic malignancies. Local control of chest wall malignancies requires wide resection with tumor-free margins. These requirements increase the risk of thoracic cavity failure and subsequent pulmonary failure. The restoration strategy for chest wall defects comprises chest wall reconstruction and soft-tissue coverage. Various reconstruction methods have been used, but both evidence and guidelines for chest wall reconstruction remain lacking. The purposes of this study were to collate our institutional experience, evaluate the outcomes of full-thickness chest wall resection and reconstruction for patients with chest wall malignant tumor, and identify problems in current practice for chest wall reconstruction with a focus on local control, complications, pulmonary function and scoliosis. Methods Participants comprised 30 patients with full-thickness chest wall malignant tumor who underwent chest wall resection and reconstruction between 1997 and 2021 in Mie University Hospital. All patients underwent chest wall resection of primary, recurrent or metastatic malignant tumors. A retrospective review was conducted for 32 operations. Results Recurrence was observed after 5 operations. Total 5-year recurrence-free survival (RFS) rate was 79.3%. Diameter ≥5 cm was significantly associated with poor RFS. The postoperative complication rate was 18.8%. Flail chest was observed with resection of ≥3 ribs in anterior and lateral resections or with sternum resection without polyethylene methylmethacrylate reconstruction. Postoperative EFV1.0% did not show any significant decrease. Postoperative %VC decreased significantly with resection of ≥4 ribs or an area of >70 cm2. Postoperative scoliosis was observed in 8 of 28 patients. Posterior resection was associated with a high prevalence of scoliosis (88.9%). Conclusion With chest wall reconstruction, risks of pulmonary impairment, flail chest and scoliosis were significantly increased. New strategies including indications for rigid reconstruction are needed to improve the outcomes of chest wall reconstruction.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
- *Correspondence: Kunihiro Asanuma,
| | - Masaya Tsujii
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Tomoki Nakamura
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Kouji Kita
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, School of medicine, Mie University, Tsu, Japan
| | - Takeshi Kataoka
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, School of medicine, Mie University, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, School of Medicine, Mie University, Tsu, Japan
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Kang J, Tian Y, Zheng J, Lu D, Cai K, Wang L, Li D. Functional design and biomechanical evaluation of 3D printing PEEK flexible implant for chest wall reconstruction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107105. [PMID: 36108412 DOI: 10.1016/j.cmpb.2022.107105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/26/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Rigid reconstruction of chest wall defect seriously affects the postoperative respiratory owing to neglecting the functional role of natural costal cartilage. In the study, a 3D printing PEEK flexible implant was developed to restore the deformation capability during breathing motion. MATERIALS AND METHODS Bionic spring structures in different region of implant were designed by taking into consideration of the anatomical morphology and materials properties of costal cartilage. The biomechanical properties of the rigid and flexible implants under the chest compression were compared through the finite element analysis. Two kinds of chest wall implant samples were fabricated with fused deposition modeling (FDM) technology to evaluate experimentally the mechanical behaviors. Finally, the restoration ability of respiratory function from the flexible implant was investigated in vivo. RESULTS The flexible implant exhibited the similar stiffness to the natural thorax and satisfied the strength demand in the chest compression. The maximal impact force of flexible implant reached to 536 N. The fatigue failure of complete flexible implant was revealed from the initiation and propagation of interlaminar crack to the fracture in a zigzag manner. Animal experiments validated that the parameters characterizing respiratory could be recovered to the preoperative and normal state. CONCLUSIONS In the study, the flexible implant provided these advantages for perfect replication of thoracic shape, reliable safety, and great deformation capability to response respiratory movement, which given a superior treatment for chest wall reconstruction.
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Affiliation(s)
- Jianfeng Kang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Jihua Laboratory, Foshan, Guangdong, China
| | - Yucong Tian
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Jibao Zheng
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Wang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China.
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Guangdong Xi'an Jiaotong University Academy, Guangdong, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China.
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8
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Repair of huge thoracic defect combined with hernia after multimodality treatment of breast cancer. Respir Med Case Rep 2021; 34:101558. [PMID: 34877252 PMCID: PMC8633021 DOI: 10.1016/j.rmcr.2021.101558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
A case of the successful reconstruction of an extensive chest wall defect combined with a ventral hernia in a patient after multimodality treatment of breast cancer complicated by sternal and costal osteomyelitis is presented. To recover the chest mechanics, with emphasis on the supporting function, and to repair the hernial defect, customized reinforced “sandwich” TiNi rib endografts and knitted TiNi surgical mesh were used. A five-year follow-up indicated no recurrence of osteomyelitis or ventral hernia, and no failure/migration of the implants or instability of the thorax. Excellent clinical and functional outcomes were achieved pursuant to the Enneking score.
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Raheem AA, Hameed P, Whenish R, Elsen RS, G A, Jaiswal AK, Prashanth KG, Manivasagam G. A Review on Development of Bio-Inspired Implants Using 3D Printing. Biomimetics (Basel) 2021; 6:65. [PMID: 34842628 PMCID: PMC8628669 DOI: 10.3390/biomimetics6040065] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 01/15/2023] Open
Abstract
Biomimetics is an emerging field of science that adapts the working principles from nature to fine-tune the engineering design aspects to mimic biological structure and functions. The application mainly focuses on the development of medical implants for hard and soft tissue replacements. Additive manufacturing or 3D printing is an established processing norm with a superior resolution and control over process parameters than conventional methods and has allowed the incessant amalgamation of biomimetics into material manufacturing, thereby improving the adaptation of biomaterials and implants into the human body. The conventional manufacturing practices had design restrictions that prevented mimicking the natural architecture of human tissues into material manufacturing. However, with additive manufacturing, the material construction happens layer-by-layer over multiple axes simultaneously, thus enabling finer control over material placement, thereby overcoming the design challenge that prevented developing complex human architectures. This review substantiates the dexterity of additive manufacturing in utilizing biomimetics to 3D print ceramic, polymer, and metal implants with excellent resemblance to natural tissue. It also cites some clinical references of experimental and commercial approaches employing biomimetic 3D printing of implants.
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Affiliation(s)
- Ansheed A. Raheem
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Pearlin Hameed
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Ruban Whenish
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Renold S. Elsen
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore 632014, India;
| | - Aswin G
- School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, India;
| | - Amit Kumar Jaiswal
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Konda Gokuldoss Prashanth
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
- Department of Mechanical and Industrial Engineering, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia
- Erich Schmid Institute of Materials Science, Austrian Academy of Science, Jahnstrasse 12, 8700 Leoben, Austria
| | - Geetha Manivasagam
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
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Chest Wall Reconstruction Using 3-Dimensional Printing: Functional and Mechanical Results. Ann Thorac Surg 2021; 114:979-988. [PMID: 34555374 DOI: 10.1016/j.athoracsur.2021.07.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/12/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tumors involving the chest wall may require extensive resection and reconstruction. This study aims to evaluate functional, cosmetic results, and quality of life (QoL) in patients who had a reconstruction based on patient-specific 3-dimensional (3D) printing. METHODS The patient-specific chest wall prosthesis was created for 10 patients. The anatomical models were 3D printed and used to produce a silicone mold that was filled with methyl methacrylate to create the customized prosthesis. Evaluation of the reconstruction was completed with a QoL assessment and postoperative tracking of patients' chest motion, using infrared markers. The distance between plot points representing markers on the operated and contralateral sides was measured to assess symmetrical motion. RESULTS Twenty-three consecutive patients were enrolled, with the median age of 64 years. Thirteen patients underwent a nonrigid reconstruction, and 10 had a patient-specific rigid reconstruction with methyl methacrylate. The median number of ribs resected was 3. No postoperative complications or morbidity related to the prostheses were reported. The median hospital stay in the nonrigid reconstruction group was 8.5 days compared with 7.5 days (p = .167) in the rigid reconstruction group. Postoperatively, most patients had low levels of symptoms, with 82% experiencing chest pain and 53% experiencing dyspnea. Rigid reconstruction patients demonstrated more symmetrical breathing motion compared with nonrigid reconstruction patients. The mean distances were 2.32 ± 2.18 and 7.28 ± 5.87 (P < .00001), respectively. CONCLUSIONS This study shows that a 3D patient-specific prosthesis is feasible and safe, suggesting a possible trend toward improved breathing mechanics, QoL, and cosmetic results.
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Laguna Sanjuanelo S, Zabaleta Jimenez J, Ramirez Gil ME, Guelbenzu Zazpe JJ, Matey Muñoz LM. “Three-dimensional printed models used for personalized precision thoracic surgery"✰. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Verma S, Sharma N, Kango S, Sharma S. Developments of PEEK (Polyetheretherketone) as a biomedical material: A focused review. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2021.110295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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13
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Garot C, Bettega G, Picart C. Additive Manufacturing of Material Scaffolds for Bone Regeneration: Toward Application in the Clinics. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2006967. [PMID: 33531885 PMCID: PMC7116655 DOI: 10.1002/adfm.202006967] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 05/07/2023]
Abstract
Additive manufacturing (AM) allows the fabrication of customized bone scaffolds in terms of shape, pore size, material type and mechanical properties. Combined with the possibility to obtain a precise 3D image of the bone defects using computed tomography or magnetic resonance imaging, it is now possible to manufacture implants for patient-specific bone regeneration. This paper reviews the state-of-the-art of the different materials and AM techniques used for the fabrication of 3D-printed scaffolds in the field of bone tissue engineering. Their advantages and drawbacks are highlighted. For materials, specific criteria, were extracted from a literature study: biomimetism to native bone, mechanical properties, biodegradability, ability to be imaged (implantation and follow-up period), histological performances and sterilization process. AM techniques can be classified in three major categories: extrusion-based, powder-based and liquid-base. Their price, ease of use and space requirement are analyzed. Different combinations of materials/AM techniques appear to be the most relevant depending on the targeted clinical applications (implantation site, presence of mechanical constraints, temporary or permanent implant). Finally, some barriers impeding the translation to human clinics are identified, notably the sterilization process.
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Affiliation(s)
- Charlotte Garot
- CEA, Université de Grenoble Alpes, CNRS, ERL 5000, IRIG Institute, 17 rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR 5628, LMGP, 3 parvis Louis Néel F-38016 Grenoble, France
| | - Georges Bettega
- Service de chirurgie maxillo-faciale, Centre Hospitalier Annecy-Genevois, 1 avenue de l’hôpital, F-74370 Epagny Metz-Tessy, France
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France
| | - Catherine Picart
- CEA, Université de Grenoble Alpes, CNRS, ERL 5000, IRIG Institute, 17 rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR 5628, LMGP, 3 parvis Louis Néel F-38016 Grenoble, France
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14
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Reconstruction of large chest wall defects using three-dimensional custom-made implant technology. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:122-125. [PMID: 33768992 PMCID: PMC7970076 DOI: 10.5606/tgkdc.dergisi.2021.19385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
It is a challenging issue for thoracic surgeons to repair and reconstruct large defects after chest wall resection without disturbing pulmonary functions. Currently, it is possible to produce nearly the same prosthesis anatomically as the original with the three-dimensional printer technology. Titanium-alloy prostheses produced with the three-dimensional prototyping technology by selective laser sintering technique meet the sensitive needs of reconstruction without impairing the functionality of the tissue. This custom-made titanium prostheses can be used for this purpose safely and effectively as a good alternative.
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15
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Vannucci J, Scarnecchia E, Potenza R, Ceccarelli S, Monopoli D, Puma F. Dynamic titanium prosthesis based on 3D-printed replica for chest wall resection and reconstruction. Transl Lung Cancer Res 2020; 9:2027-2032. [PMID: 33209622 PMCID: PMC7653105 DOI: 10.21037/tlcr-20-699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
3D-printing technologies can assist the surgical planning and prosthesis engineering for the management of extended chest wall resection. Different types of prosthesis have been utilized over time, but some concerns remain about their impact on the respiratory function. Here we present a new kind of 3D-printed titanium prosthesis designed to be either strong and flexible. The prosthesis was created on a 1:1 3D-printed anatomic replica of the chest, used to delineate surgical margins and to define the reconstructive requirements.
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Affiliation(s)
- Jacopo Vannucci
- Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Elisa Scarnecchia
- Department of Thoracic Surgery and Thoracic Endoscopy, Eugenio Morelli Hospital, Sondalo, SO, Italy.,Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rossella Potenza
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Silvia Ceccarelli
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Donato Monopoli
- Instituto Tecnológico de Canarias (ITC) Osteobionix, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
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Girotti PNC, Königsrainer I, Pastorino U, Girotti AL, Rosa F. Optimal chest wall prosthesis: comparative study of mechanical and functional behaviour. Eur J Cardiothorac Surg 2020; 59:ezaa355. [PMID: 33188690 DOI: 10.1093/ejcts/ezaa355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Chest wall resections are most commonly performed for tumours, infection, radiation necrosis and trauma. Defects in the anterior chest greater than 5 cm, posterior defects more than 10 cm or resection including more than 3 ribs, independently of the location, require skeletal prosthetic reconstruction. The aim of this paper was to evaluate the strength of prostheses that reproduced the normal human anatomy using different materials subjected to the most dangerous loading conditions. METHODS The biomechanical behaviours of different prosthetic materials under critical rib fracture conditions were analysed using the finite element method and then validated through mechanical testing of 3-dimensional polymethylmethacrylate ribs as a prosthesis reproducing the native anatomy of the human ribcage. RESULTS The prosthetic materials and the polymethylmethacrylate prosthesis were tested under 3 load conditions: sternal load (an anterior-posterior load applied at the third rib); lateral load (strength applied at the lateral arch of the fifth rib) and vertical load (vertical load applied at the first sternocostal junction) and showed the same results in terms of failures compared to the results from the finite element method model simulation (same location and number of fractures were detected). Although the displacement error between the finite element method and experimental test was up to 5% overall, no other microcracking was observed. CONCLUSIONS This experimental study demonstrated that all prosthetic materials currently available for human use show optimal mechanical behaviour in term of resistance and organ protection. Specifically, polymethylmethacrylate was a good candidate as a prosthetic material in term of lightness, resistance and prosthetic weight.
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Affiliation(s)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Ugo Pastorino
- Department of Thoracic Surgery, National Institute of Cancer, Milan, Italy
| | | | - Francesco Rosa
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant. 3D Print Med 2020; 6:26. [PMID: 32975713 PMCID: PMC7519505 DOI: 10.1186/s41205-020-00079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant. METHOD To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient's chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially. RESULTS Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant. CONCLUSION Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.
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Abstract
Additive manufacturing (AM) processes have undergone significant progress in recent years, having been implemented in sectors as diverse as automotive, aerospace, electrical component manufacturing, etc. In the medical sector, different devices are printed, such as implants, surgical guides, scaffolds, tissue engineering, etc. Although nowadays some implants are made of plastics or ceramics, metals have been traditionally employed in their manufacture. However, metallic implants obtained by traditional methods such as machining have the drawbacks that they are manufactured in standard sizes, and that it is difficult to obtain porous structures that favor fixation of the prostheses by means of osseointegration. The present paper presents an overview of the use of AM technologies to manufacture metallic implants. First, the different technologies used for metals are presented, focusing on the main advantages and drawbacks of each one of them. Considered technologies are binder jetting (BJ), selective laser melting (SLM), electron beam melting (EBM), direct energy deposition (DED), and material extrusion by fused filament fabrication (FFF) with metal filled polymers. Then, different metals used in the medical sector are listed, and their properties are summarized, with the focus on Ti and CoCr alloys. They are divided into two groups, namely ferrous and non-ferrous alloys. Finally, the state-of-art about the manufacture of metallic implants with AM technologies is summarized. The present paper will help to explain the latest progress in the application of AM processes to the manufacture of implants.
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Zhang C, Wang L, Kang J, Fuentes OM, Li D. Bionic design and verification of 3D printed PEEK costal cartilage prosthesis. J Mech Behav Biomed Mater 2020; 103:103561. [DOI: 10.1016/j.jmbbm.2019.103561] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/09/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023]
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Tamburini N, Grossi W, Sanna S, Campisi A, Londero F, Maniscalco P, Dolci G, Quarantotto F, Daddi N, Morelli A, Cavallesco G, Dell'Amore A. Chest wall reconstruction using a new titanium mesh: a multicenters experience. J Thorac Dis 2019; 11:3459-3466. [PMID: 31559051 DOI: 10.21037/jtd.2019.07.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Many new surgical techniques and materials have been introduced in the last decade for chest wall reconstruction or stabilization with the purpose of improving the incorporation, maintaining chest wall stability with reduction of infections. However, none of them are yet considered a gold standard procedure. The aim of this work is to evaluate the initial experience using a new titanium mesh for chest wall reconstruction in four Italian Thoracic Surgery Departments. Methods A review was performed of all patients undergoing chest wall reconstruction using a new titanium mesh between January 2014 and September 2018. Surgical indications, the location and size of the chest wall defect, intraoperative variables and postoperative complications were analyzed. Results A total of 26 consecutive patients were included. The most common indications for surgery were primary or secondary chest wall tumors (38%) followed by lung cancer invading chest wall (31%). The most common localization of chest wall defect was anterolateral (46%). Sternal reconstruction was required in 3 patients (12%). The average size of the defect was 9.3×7.8 cm. The median number of resected ribs was 3.6. No perioperative deaths occurred. Mean hospital stay was 11.9 days. Overall morbidity was 19%. One failure of reconstruction (4%) was reported during follow up. Conclusions In our early clinical experience chest wall reconstruction using titanium mesh can be performed as a safe and effective surgical procedure. This mesh has excellent biomechanical characteristics between rigid and malleable materials, it's easy to trim and fix for optimal adaptation without necessity of dedicated instruments. The early and mid-term results are satisfactory with low incidence of complications related to the titanium mesh implant.
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Affiliation(s)
- Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - William Grossi
- Department of CardioThoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Stefano Sanna
- Thoracic Surgery Unit, G.B. Morgagni Hospital, Forlì, Italy
| | - Alessio Campisi
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Francesco Londero
- Department of CardioThoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Pio Maniscalco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giampiero Dolci
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Francesco Quarantotto
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Niccolò Daddi
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Angelo Morelli
- Department of CardioThoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Giorgio Cavallesco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Andrea Dell'Amore
- Department of CardioThoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
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21
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Wang L, Huang L, Li X, Zhong D, Li D, Cao T, Yang S, Yan X, Zhao J, He J, Cao Y, Wang L. Three-Dimensional Printing PEEK Implant: A Novel Choice for the Reconstruction of Chest Wall Defect. Ann Thorac Surg 2019; 107:921-928. [DOI: 10.1016/j.athoracsur.2018.09.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/28/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
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Abstract
Pediatric chest wall tumors are rare. Malignancies predominate of which sarcomas are the most common. Their resection and the subsequent reconstruction of the chest wall has been a surgical challenge since Dr. Frederick W. Parham published his first comprehensive account on the subject in 1898. Chest wall reconstruction is age, site and pathology dependent, must preserve long term function and cosmesis, must accommodate future growth and development, and must not be a hindrance to adjuvant radiotherapy. Bony reconstruction can be relatively simple or complex involving combinations of synthetic meshes, bioprosthetic materials, steel or titanium constructs, autografts, homografts and porcine or bovine xenografts. Soft tissue coverage can be achieved with direct closure, skin grafts, local advancement flaps, pedicled or free myocutaneous or osseomyocutaneous flaps or a combination of these. Complications to be avoided include scoliosis, pain and activity restriction, restrictive pulmonary deficits and interference with adjuvant radiotherapy which may result in tumor recurrence. Advances in cancer therapy have improved short- and long-term survival but significant functional and cosmetic challenges remain particularly for large chest wall defects in the very young. The future may lie with absorbable semi-rigid meshes, biointegratable acellular homografts and xenografts, demineralized bone matrices and bone marrow stromal cells, the patient's own lab-grown stem-cell based vascularized osseomyocutaneous chest wall grafts or the obsolescence of surgical resection altogether in the age of targeted anti-tumor and immune based therapy.
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Affiliation(s)
- Gideon Sandler
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street 17.6053, External Mail: Unit 1484, Houston, TX 77030, United States of America.
| | - Andrea Hayes-Jordan
- Pediatric Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street 17.6053, External Mail: Unit 1484, Houston, TX 77030, United States of America.
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Kang J, Wang L, Yang C, Wang L, Yi C, He J, Li D. Custom design and biomechanical analysis of 3D-printed PEEK rib prostheses. Biomech Model Mechanobiol 2018; 17:1083-1092. [PMID: 29730771 DOI: 10.1007/s10237-018-1015-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
A tumour resection normally involves a large tissue resection and bone replacement. Polyether ether ketone (PEEK) has become a suitable candidate for use in various prostheses owing to its lightness in weight, modulus close to that of natural bone, and good biocompatibility, among other factors. This study proposes a new design method for a rib prosthesis using the centroid trajectory of the natural replaced rib, where the strength can be adjusted by monitoring the cross-sectional area, shape, and properties. A custom-designed rib prosthesis was manufactured using fused deposition modelling (FDM) manufacturing technology, and the mechanical behaviour was found to be close to that of a natural rib. A finite element analysis of the designed rib was carried out under similar loading conditions to those used in mechanical testing. The results indicate that the centroid trajectory derived from a natural rib diaphysis can provide reliable guidance for the design of a rib prosthesis. Such methodology not only offers considerable design freedom in terms of shape and required strength, but also benefits the quality of the surface finishing for samples manufactured using the FDM technique. FDM-printed PEEK rib prostheses have been successfully implanted, and good clinical performances have been achieved.
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Affiliation(s)
- Jianfeng Kang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Ling Wang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China.
| | - Chuncheng Yang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Lei Wang
- Departments of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaan Xi, China
| | - Cao Yi
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Jiankang He
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
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24
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Kwok JKS, Lau RWH, Zhao ZR, Yu PSY, Ho JYK, Chow SCY, Wan IYP, Ng CSH. Multi-dimensional printing in thoracic surgery: current and future applications. J Thorac Dis 2018; 10:S756-S763. [PMID: 29732197 DOI: 10.21037/jtd.2018.02.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Three-dimensional (3D) printing has been gaining much attention in the medical field in recent years. At present, 3D printing most commonly contributes in pre-operative surgical planning of complicated surgery. It is also utilized for producing personalized prosthesis, well demonstrated by the customized rib cage, vertebral body models and customized airway splints. With on-going research and development, it will likely play an increasingly important role across the surgical fields. This article reviews current application of 3D printing in thoracic surgery and also provides a brief overview on the extended and updated use of 3D printing in bioprinting and 4D printing.
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Affiliation(s)
- Jackson K S Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ze-Rui Zhao
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jacky Y K Ho
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Y P Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Reconstruction of the anterior chest wall with a 3-dimensionally printed biodynamic prosthesis. J Thorac Cardiovasc Surg 2017; 155:e59-e60. [PMID: 28986038 DOI: 10.1016/j.jtcvs.2017.08.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/04/2017] [Accepted: 08/27/2017] [Indexed: 11/20/2022]
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Sanna S, Brandolini J, Pardolesi A, Argnani D, Mengozzi M, Dell'Amore A, Solli P. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3:95. [PMID: 29078657 DOI: 10.21037/jovs.2017.06.10] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/15/2017] [Indexed: 01/22/2023]
Abstract
Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.
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Affiliation(s)
- Stefano Sanna
- Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy
| | - Jury Brandolini
- Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy
| | | | | | - Marta Mengozzi
- Thoracic Surgery Unit, G. B. Morgagni Hospital, Forli, Italy
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Nassereddine H, Larousserie F, Campagna R, Castier Y, Couvelard A, Choudat L, Sannier A. Xanthomatous Posttraumatic Fibro-Osseous Lesion of the Rib: A Rare and Underrecognized Entity. Case Report and Literature Review. Int J Surg Pathol 2017; 25:640-643. [PMID: 28580818 DOI: 10.1177/1066896917712455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Posttraumatic fibro-osseous lesion (PTFOL) is a rare lesion that typically affects the ribs and is probably a posttraumatic reactive process. Because PTFOL is often misdiagnosed as fibrous dysplasia, osteoid osteoma, benign fibrous histiocytoma or rib metastases, chest wall resection, leading to a significant morbidity, is the main treatment modality. We report the case of a 30-year-old male patient with no history of previous trauma presenting with chest pain. Computed tomography scan showed an eighth left rib well-defined ovoid and hypodense lesion with circumferential sclerotic margin and no cortical breakthrough. Posterolateral thoracotomy was performed and a histological diagnosis of xanthomatous posttraumatic fibro-osseous lesion of the rib was made. PTFOL is a benign lesion that should be recognized to avoid unnecessary surgical treatment and complications. We provide a summary of clinical, histopathological, and radiological aspects of PTFOL and discuss differential diagnoses.
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Affiliation(s)
- Hussein Nassereddine
- 1 Bichat Hospital, AP-HP, Paris, France.,2 Paris Descartes University, Paris, France
| | | | | | - Yves Castier
- 1 Bichat Hospital, AP-HP, Paris, France.,4 Paris Diderot University, Paris, France
| | - Anne Couvelard
- 1 Bichat Hospital, AP-HP, Paris, France.,4 Paris Diderot University, Paris, France
| | | | - Aurélie Sannier
- 1 Bichat Hospital, AP-HP, Paris, France.,4 Paris Diderot University, Paris, France
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Simal I, García-Casillas MA, Cerdá JA, Riquelme Ó, Lorca-García C, Pérez-Egido L, Fernández-Bautista B, Torre MDL, de Agustín JC. Three-Dimensional Custom-Made Titanium Ribs for Reconstruction of a Large Chest Wall Defect. European J Pediatr Surg Rep 2016; 4:26-30. [PMID: 28018805 PMCID: PMC5177554 DOI: 10.1055/s-0036-1593738] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/03/2016] [Indexed: 01/30/2023] Open
Abstract
Reconstruction of large chest wall defects always demand surgeons of having lots of means available (both materials and resourceful) to apply a cover to chest wall defects which can range from a few centimeters to the lack of a few entire ribs. In this study, we present the case of a teenager who suffered from a complete resection of three ribs because of Ewing sarcoma dependent on the sixth rib. Given the size of the defect, a multidisciplinary approach was chosen to provide rigid and soft tissue coverage and minimal functional and aesthetic impact. Custom-made titanium implants were designed based on three-dimensional computed tomography scan reconstruction. The surgical specimen via a left lateral thoracotomy (fifth, sixth, and seventh entire ribs) was resected, leaving a defect of 35 × 12 × 6 cm. A Gore-Tex patch (W. L. Gore & Associates, Arizona, United States) was placed and, after that, the implants were anchored to the posterior fragment of the healthy ribs and to the costal cartilage anteriorly. Finally, the surgical site was covered with a latissimus dorsi flap. The postoperative course was uneventful. After 9 months of follow-up, the patient has full mobility. This case shows that the implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects. The implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects.
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Affiliation(s)
- Isabel Simal
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | | | - Julio Arturo Cerdá
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | - Óscar Riquelme
- Department of Pediatric Traumatology and Orthopedics, Gregorio Marañon University Hospital, Madrid, Spain
| | - Concepción Lorca-García
- Department of Pediatric Plastic Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | - Laura Pérez-Egido
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
| | | | - Manuel de la Torre
- Department of Pediatric Surgery, Gregorio Marañon University Hospital, Madrid, Spain
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