Abstract
BackgroundChest 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.MethodTo 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.ResultsHistology 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.ConclusionOur 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.
Highlights
Chondrosarcoma of the chest wall is rare, and when diagnosed requires a full thickness wide local excision of the tumor and chest wall to ensure tumor-free margins, minimize local recurrence and contribute to long-term survival [1]
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
We describe the use of this technology in an adult male who underwent a wide surgical excision of a chest wall chondrosarcoma followed by reconstruction of the resulting large skeletal defect with a custom-made 3-D printed anatomical ribs and hemi-sternum titanium alloy implant
Summary
Chondrosarcoma of the chest wall is rare, and when diagnosed requires a full thickness wide local excision of the tumor and chest wall to ensure tumor-free margins, minimize local recurrence and contribute to long-term survival [1]. A wide local excision of the chest (2020) 6:26 laser printing technology for titanium implants can help simplify this challenge and reduce the surgical operating time. We describe the use of this technology in an adult male who underwent a wide surgical excision of a chest wall chondrosarcoma followed by reconstruction of the resulting large skeletal defect with a custom-made 3-D printed anatomical ribs and hemi-sternum titanium alloy implant. 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
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