Clinical application of 3D printed titanium chest and rib implants in chest wall reconstruction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Hao ¹ ,  HUANG Lijun ¹ , ZHU Yifang ¹ , YANG Sanhu ¹ , LIU Xi ¹ , CAO Tiesheng ² , LIANG Jiahe ² , GUO Yitong ² ,  WANG Lei ¹ ,  LI Xiaofei ¹

1. Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, 710038, P.R.China;
2. 3D Printing Center of Tangdu Hospital, Fourth Military Medical University, Xi’an, 710038, P.R.China;

Corresponding author：

WANG Lei, Email: tuodi1986@126.com; LI Xiaofei, Email: lxfchest@fmmu.edu.cn

Keywords：

Three-dimensional printing; titanium; chest wall reconstruction

DOI：

10.7507/1007-4848.201911029

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Objective In this study, three-dimensional printed (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 There were 13 patients [mean age of 46 (24-78) years with 9 males and 4 females] who underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP titanium implants. Surgical data including patient demographic characteristics, perioperative clinical data and data from 1-year follow-up were collected and analyzed.Results Six patients of rib tumors, six patients of sternal tumors and one patient of sternal pyogenic osteomyelitis were finally selected for the study. The chest wall defect area was 221.0±206.0 cm². All patients were able to maintain the integrity of the chest wall after surgery, and no abnormal 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 25.0%. Two patients died of tumor recurrence, with a mortality rate of 16.7%.Conclusion 3DP titanium implant is a safe and effective material for chest wall reconstruction.

Citation： ZHANG Hao, HUANG Lijun, ZHU Yifang, YANG Sanhu, LIU Xi, CAO Tiesheng, LIANG Jiahe, GUO Yitong, WANG Lei, LI Xiaofei. Clinical application of 3D printed titanium chest and rib implants in chest wall reconstruction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 268-273. doi: 10.7507/1007-4848.201911029 Copy

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2.	Zhang Y, Li JZ, Hao YJ, et al. Sternal tumor resection and reconstruction with titanium mesh: a preliminary study. Orthop Surg, 2015, 7(2): 155-160.
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4.	Deschamps C, Tirnaksiz BM, Darbandi R, et al. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg, 1999, 117(3): 588-591.
5.	Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg, 2002, 73(6): 1720-1726.
6.	Khullar OV, Fernandez FG. Prosthetic reconstruction of the chest wall. Thorac Surg Clin, 2017, 27(2): 201-208.
7.	Wang L, Cao T, Li X, et al. Three-dimensional printing titanium ribs for complex reconstruction after extensive posterolateral chest wall resection in lung cancer. J Thorac Cardiovasc Surg, 2016, 152(1): e5-e7.
8.	Berthet JP, Gomez Caro A, Solovei L, et al. Titanium implant failure after chest wall osteosynthesis. Ann Thorac Surg, 2015, 99(6): 1945-1952.
9.	Att W, Hori N, Iwasa F, et al. The effect of UV-photofunctionalization on the time-related bioactivity of titanium and chromium-cobalt alloys. Biomaterials, 2009, 30(26): 4268-4276.
10.	Naoum GE, Salama L, Ho A, et al. The impact of chest wall boost on reconstruction complications and local control in patients treated for breast cancer. Int J Radiat Oncol Biol Phys, 2019, 105(1): 155-164.
11.	Wael Att, Norio Hori, Fuminori Iwasa, et al. The effect of UV-photofunctionalization on the time-related bioactivity of titanium and chromium–cobalt alloys. Biomaterials, 2009, 30: 4268-4276.

1. Weyant MJ, Bains MS, Venkatraman E, et al. Results of chest wall resection and reconstruction with and without rigid prosthesis. Ann Thorac Surg, 2006, 81(1): 279-285.
2. Zhang Y, Li JZ, Hao YJ, et al. Sternal tumor resection and reconstruction with titanium mesh: a preliminary study. Orthop Surg, 2015, 7(2): 155-160.
3. 王磊, 李靖, 钟代星, 等. 中国胸壁肿瘤切除及胸壁重建手术专家共识(2018 版). 中国胸心血管外科临床杂志, 2019, 26(1): 1-7.
4. Deschamps C, Tirnaksiz BM, Darbandi R, et al. Early and long-term results of prosthetic chest wall reconstruction. J Thorac Cardiovasc Surg, 1999, 117(3): 588-591.
5. Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg, 2002, 73(6): 1720-1726.
6. Khullar OV, Fernandez FG. Prosthetic reconstruction of the chest wall. Thorac Surg Clin, 2017, 27(2): 201-208.
7. Wang L, Cao T, Li X, et al. Three-dimensional printing titanium ribs for complex reconstruction after extensive posterolateral chest wall resection in lung cancer. J Thorac Cardiovasc Surg, 2016, 152(1): e5-e7.
8. Berthet JP, Gomez Caro A, Solovei L, et al. Titanium implant failure after chest wall osteosynthesis. Ann Thorac Surg, 2015, 99(6): 1945-1952.
9. Att W, Hori N, Iwasa F, et al. The effect of UV-photofunctionalization on the time-related bioactivity of titanium and chromium-cobalt alloys. Biomaterials, 2009, 30(26): 4268-4276.
10. Naoum GE, Salama L, Ho A, et al. The impact of chest wall boost on reconstruction complications and local control in patients treated for breast cancer. Int J Radiat Oncol Biol Phys, 2019, 105(1): 155-164.
11. Wael Att, Norio Hori, Fuminori Iwasa, et al. The effect of UV-photofunctionalization on the time-related bioactivity of titanium and chromium–cobalt alloys. Biomaterials, 2009, 30: 4268-4276.

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Clinical application of 3D printed titanium chest and rib implants in chest wall reconstruction

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