Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

Three-dimensional technologies in chest wall resection and reconstruction

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.

Attachment Issues: A Case Report of a Promising Sternal Implantation with 3D-printed Polyethylene

Sternal reconstruction is beneficial for chest wall stability, respiratory function, and cosmetics, with no superior prosthesis or method thus far identified. We present a case of sternal reconstruction in a patient 6 years post sternal removal using a 3D-printed, patient-specific, polyethylene prosthesis with reasonable short-term outcomes. We believe a polyethylene prosthesis shows advantages over other materials and is worth further investigation, providing a technique for attaching said prosthesis to the native tissues is established.

Dynamic titanium prosthesis based on 3D-printed replica for chest wall resection and reconstruction

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.

Three-Dimensional-Printed Model as a Template for Chest Wall Reconstruction

BACKGROUND

To our knowledge, this is the first time that a three-dimensional (3D)-printed model was used as an intraoperative template to recreate the resected portion of the lateral chest wall after resection of a large chest-wall tumour.

METHODS

Fabrication of 3D-printed models requires collaboration among a surgeon, radiologist, segmenter, and 3D printing centre. Three-dimensional models are created with computed tomographic and magnetic resonance data. These models can provide an accurate guide for surgical resection and can be used intraoperatively as a template to construct tailored prostheses.

RESULTS

We achieved complete resection of the chest wall defect, restored skeletal function and physiologic chest excursion, and achieved the best cosmetic appearance in all cases.

CONCLUSIONS

Small- to medium-sized chest wall defects can be repaired with musculocutaneous flaps with or without prosthetic materials, but more complicated defects require increasingly sophisticated reconstructive techniques and technologies. An advanced technique is the use of a 3D-printed model of the chest wall as an intraoperative template.

Reconstruction of massive chest wall defects: A 20-year experience

BACKGROUND

Large chest wall resections can result in paradoxical chest wall movement leading to prolonged ventilator dependence and major respiratory impairment. The purpose of this study was to determine as to which factors are predictive or protective of complications in massive oncologic chest wall defect reconstructions.

METHODS

A retrospective review of a prospectively maintained database of consecutive patients who underwent immediate reconstruction of massive thoracic oncologic defects (≥5 ribs) was performed. Univariate and multivariate logistic regression analyses identified risk factors.

RESULTS

We identified 59 patients (median age, 53 years) with a mean follow-up of 36 months. Rib resections ranged from 5 to 10 ribs (defect area, 80-690 cm²). Sixty-two percent of the patients developed at least one postoperative complication. Superior/middle resections were associated with increased risk of general and pulmonary complications (71.4% vs. 35.3%; OR 4.54; p = 0.013). The 90-day mortality rate following massive chest wall resection and reconstruction was 8.5%. Two factors that were significantly associated with shorter overall survival time were preoperative XRT and preoperative chemotherapy (p = 0.021 and p < 0.001, respectively).

CONCLUSIONS

Patients with massive oncological thoracic defects have a high rate of reconstructive complications, particularly pulmonary, leading to prolonged ventilator dependence. Superior resections were more likely to be associated with increased pulmonary and overall complications. The length of postoperative recovery was significantly associated with the size of the defect, and larger defects had prolonged hospital stays. Because of the large dimensions of chest wall defects, almost half of the cases required flap coverage to allow for appropriate defect closure. Understanding the unique demands of these rare but challenging cases is critically important in predicting patient outcomes.

Can surgery relieve pain and act as first-line treatment for a large metastasis of the sternum?

BACKGROUND

There are few papers published on sternal metastasis from renal cell carcinoma. The unifying element is the operability of the sternal metastasis if it is the only site of metastasis, on the operability of the primary site of the tumor and on the patient's health conditions.

PRESENTATION OF THE CASE

We present a case of a 66-years-old man undergone sternal resection for a large painful metastasis. He was previously undergone left nephrectomy for clear cells carcinoma. En bloc resection of the sternal manubrium and right clavicle was performed, a Gore-Tex mesh was placed. Histology confirmed metastasis of kidney clear cells carcinoma. Patient was discharged with no complications and no pain. Chest CT at six months follow up was negative for recurrence.

DISCUSSION AND CONCLUSION

We highlighted the importance of surgery as possible first-line treatment in symptomatic large sternum metastasis. Therefore, prospective studies should be considered to confirm our strategy.

Application of 3D printing technology to thoracic wall tumor resection and thoracic wall reconstruction

Background

Thoracic wall tumors can leave large defects in the thoracic wall after tumor resection. Currently, the shape of the materials commonly used for thoracic wall repair, including dacron mesh and titanium alloy mesh, cannot readily conform to the shapes of defect sites. In this study, we aimed to retrospectively review and evaluate the outcomes of applying three-dimensional (3D) printing technology in assisting in thoracic wall tumor resection and thoracic wall construction.

Methods

Six patients with thoracic wall tumors underwent thin-slice CT scanning. We 3D reconstructed pleural tumors and adjacent structures with Amira software and 3D printed them. Preoperative simulation, surgical rehearsal, and surgical planning were performed, and 3D conformal titanium plates were created based on 3D reconstruction models and sutured to the defect sites of the thoracic wall. We also retrospectively reviewed 10 patients who underwent this surgery with conventional methods. All of the demographic data, clinical data, and laboratory findings (non-normally distributed variables) were compared between these two groups.

Results

3D reconstructions of the tumors and their adjacent structures were successfully performed, and 3D printing physical models and conformal titanium plates were also successfully obtained. The plate afforded accurate matching, less bleeding, fewer postoperative complications, and less pain.

Conclusions

This 3D printing technology can aid in preoperative rehearsal, surgical planning, and the manufacturing of 3D implants. The 3D titanium plate has such advantages over traditional implants as having good fit and hardness, improving the surgical accuracy and curative effect, and reducing complications, such as bleeding and pain.

Total talar replacement with a novel 3D printed modular prosthesis for tumors

Purpose

Arthrodesis is one of the most widely accepted surgical recommended methods for tumors of the talus, but it may be associated with poor limb functions. The aim of this study was to present a novel reconstruction with ankle function preserved after en bloc talus tumor resection.

Patient and method

A 43-year-old female with mesenchymal sarcoma of the talus was admitted in West China Hospital. Total talar replacement with three-dimensional (3D) printed modular prosthesis was prepared for reconstruction. The 3D printed modular prosthesis was designed exactly as the mirror image of the contralateral talus with complete filling of the sinus tarsi and subtalar joint space. The upper modular component of prosthesis was made of ultra high molecular weight polyethylene, and the lower component, titanium alloy. Pre-drilled holes in three directions were prepared for screw fixation of the subtalar joint.

Results

The patient underwent en bloc talus resection through anterior approach, followed by reconstruction with the 3D printed prosthesis. The whole procedure took 2 hours, and intra-operative blood loss was 50 mL. At the last follow-up, our patient was disease free and she could walk almost normally without any aid or pain. The Musculoskeletal Tumor Society score was 26/30. The American Orthopedic Foot and Ankle Society score was 91/100. The range of motion for dorsiflexion and plantar flexion was 40°. And no abnormalities were observed in the roentgenograph.

Conclusion

Total talar replacement with a 3D printed modular prosthesis may be an effective procedure for patients with tumors of the talus as it could maintain ankle function.