3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Goldsmith, Ira; Dovgalski, Lawrence; Evans, Peter Llewelyn
• Is Part Of: Innovations. Volume 18:Issue 1(2023)
• Page Start: 67
• Page End: 72
• Publication Date: 2023-01
• Subjects: 3D-printing technology -- titanium implant -- chest wall reconstruction -- sternum -- ribs; Cardiovascular system -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; Thoracic Surgical Procedures -- methods -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Thorax -- Chirurgie -- Méthodologie -- Périodiques; Vaisseaux sanguins -- Chirurgie -- Méthodologie -- Périodiques; Blood-vessels -- Surgery; Chest -- Surgery; Periodicals; 617.41
• DOI: 10.1177/15569845231153632
• Languages: English
• ISSNs: 1556-9845

Abstract

Objective: We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture. Methods: We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor. For all-around tumor-free margins, we grew the tumor by 2 cm. The replacement implant was designed in 3D using the anatomical features of the sternum, cartilages, and ribs and manufactured using TiMG 1 powder fusion technology. Physiotherapy was provided prior to and following surgery, and the impact of reconstruction on pulmonary functions was assessed. Results: At surgery, the precise resection, clear margins, and a secure fit were achieved. At follow-up, there was no dislocation, paradoxical movement, change in performance status, or dyspnea. There was a decrease in forced expiratory volume in 1 s (FEV1 ) from 105% prior to surgery to 82% following surgery and in forced vital capacity (FVC) from 108% to 75%, with no difference in the FEV1 /FVC ratio, suggesting a restrictive pattern of impairment. Conclusions: With 3D printing technology, reconstructing a large anterior chest wall defect with a custom-made, anatomical, 3D-printed titanium alloy implant is feasible and safe, and it preserves the shape, structure, and function of the chest wall, albeit with a restrictive pattern of pulmonary function, which can be addressed with physiotherapy. Visual abstract