Clinical Application Of 3d Printed Thoracic And Rib Implants In Chest Wall Reconstruction

Section 1 Clinical application of 3D printed titanium chest and rib implants in chest wall reconstructionObjectives.In this study,three-dimensional printing(3DP)titanium implants were used for skeletal reconstructions after wide excision of chest wall.3DP titanium implants were expected to provide a valid option with perfect anatomic fitting and personalized design in chest wall reconstruction.Methods.Thirteen patients(mean age,46 years),comprising 9 males and 4 females,underwent adequate radical wide excision for tumors and chest wall reconstruction using3DP titanium implants.Surgical data,which includes patient demographic characteristics and perioperative clinical data and data from 1-year follow-up were collected and analyzed.Results.Six patients with rib tumors,6 patients with sternal tumors and one patient with sternal pyogenic osteomyelitis were selected in the study.The chest wall defect area was 221±206 cm~2.All patients were able to maintain the integrity of the chest wall after surgery,and no paradoxical breathing was found,achieving personalized and anatomical repair.Thirteen patients were successfully discharged from the hospital.Two patients developed pneumonia in the perioperative period.During the follow-up period in the first year after surgery,no implant related adverse reaction was observed,including implant rupture,implant shift,rejection reaction and allergies.One patient had wound ulcer after chemotherapy.Three patients had tumor recurrence,with the recurrence rate of 25%.Two patients died of tumor recurrence,with a mortality rate of 16.7%.Conclusions.3DP titanium implant is a safe and effective material for reconstruction,which can meet personalized and anatomical requirements for chest wall reconstruction.Section 2 Necessity of pleura repair in the chest wall reconstruction with three-dimensional printed titanium implantObjectives.We noticed that maintaining the stability of the pleural cavity is of great significance for patients’perioperative recovery in clinical practice.The purpose of this study was to investigate the necessity of pleural reconstruction in 3D printed titanium alloy implant chest wall reconstruction surgery.Methods.Five patients with chest wall tumors underwent wide excision of the tumor in the anterolateral or posterior chest wall.The chest wall defect was repaired using the3DP titanium implants and the myocutaneous pedicled flap.But no pleura repair was performed in case 1 and case 2.For the next 3 patients,the deantigenic mesenteric mesh was densely suspended on the inner surface of titanium implants.Clinical data and chest CT images of all patients were collected after surgery.Results.Two patients without pleura repair were not extubated until the daily drainage is less than 40 ml in 2 months after surgery.Chest CT images showed localized pleural effusion between lung and the titanium implants.The next 3 patients were discharged home 10 days after surgery and the chest CT scan showed a stable reconstruction,preservation of thoracic morphology and excellent cosmetic results.Conclusions.Pleura repair was necessary in the chest wall reconstruction using three-dimensional printed titanium implant.Section 3 Clinical application of 3D printed PEEK chest and rib implants in chest wall reconstructionObjectives.After enlarged chest wall resection,the use of 3D-printed PEEK implants for chest wall reconstruction is expected to provide a better effect than traditional implants because 3D-printed PEEK implants are closer to the elastic modulus of bone cortex and have similar biomechanical properties.Methods.Twenty-five patients(mean age,46 years),comprising 11 males and 14females,underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP PEEK implants.Clinical data of patients,which includes general demographic characteristics,surgical-related indicators,imaging data,postoperative complications,and pulmonary function data before and 1 month after operation were collected and analyzed.Results.Eleven patients with sternal lesions and 14 patients with rib lesions were selected for the study.The mean chest wall defect size was(187±196)cm~2(range 56 to1050 cm ~2).All patients were able to maintain the integrity of the chest wall,achieving personalized and anatomical repair.The FEV1 and FVC of the patients showed that there was a significant difference between preoperative and postoperative 1 month(P<0.05).All patients were successfully discharged without implant breakage,displacement,rejection reaction and allergies.Five patients had respiratory-related complications such as pneumonia during the perioperative period(20%).One case was infected after an incision ulcer and the implant was bare.Conclusions.The 3D-printed PEEK implant is a safe and effective chest wall defect reconstruction material.Although the lung function of the patient has decreased after the operation,the patient’s basic ventilation function can be guaranteed.