Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Çaylak, Hasan; Gökçe, Hasan; Demirkaya, Ahmet

doi:10.1093/icvts/ivt408

Cited by 44 publications

(32 citation statements)

References 6 publications

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“…A new recent development could be a computed tomography with reconstructed 3-dimensional (3D) images, that could guide the production, via a 3D printing technology, accurate resin, polymer, metal and degradable biomaterial prosthesis. A combination of materials can be used, some biodegradable, others to make rigid the structure and more exciting evolution should be a 3-D printing bioscaffold, that allows the growth and colonization by patient's own cells into (58,59).…”

Section: A Look Into the Futurementioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage. by scapula and shoulder girdle, with the exception of defects lower than 4th rib posteriorly, with the tip of the scapula at risk to entrapment (3,12,13). With the increased availability of reconstruction materials, then, and particularly biologic materials, some surgeons proposed the reconstruction of nearly all chest wall defects, with the objective to avoid patient perception of chest wall instability (3,5,13).The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs, provide soft tissue coverage, minimize deformity and allow patients to receive adjuvant radiotherapy if indicated (3,9). Therefore, a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons as well as medical and radiation oncologists is essential.Actually several synthetic, biologic, and metallic materials are available to reconstruct the chest wall defects, but each prosthetic material has its own advantages and disadvantages and none have proven to be clearly superior (4,12). In particular, the benefit of each material and technique of reconstruction need to be weighed against to main indicators, as the risk of infection and other major complications that could be fail the reconstructive result.The recent advance in allograft and homograft production have provided new alternatives for restoring structural stability, preventing the infective complications (3,14).We would describe the main reconstructive techniques and materials more adopted on Literature reports and an overview to the incoming future of chest wall reconstruction. Synthetic, biologic and titanium meshesThe use of a metal prostheses was first reported by a French surgeon in 1909 (15), but in the 1940s better-tolerated and easier to use materials, as plastic components emerged, modifying the ...

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Section: A Look Into the Futurementioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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“…• Report results openly, both negative and positive, to ensure that mistakes are not repeated Open porous scaffold with rectangular strut: width 400 µm and height 800 µm Bone formation Triangular, hexagonal and rectangular pore shapes; 500 and 1000 µm pore size; strut size 200 µm; stiffness from 0.45 to 11 GPa Small pores -initial cell attachment; large non-circular pores -avoid pore occlusion *not strictly an AM porosity, but an AM feature that creates a non-solid area to improve implant stability. 1 2 Ti-6Al-4V 8, 11, 14, 15, 22, 27, 36, 40, 42-44, 48, 49, 55, 57, 58, 67, 70 Ti-6Al-4V ELI 10,19,20,25,35,37,39,52 Co-28Cr-6Mo…”

Section: Discussionmentioning

confidence: 99%

“…Case study [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Clinical animal study 2 27,28 Applied non-clinical 10 [29][30][31][32][33][34][35][36][37][38] Animal study 14 [39][40][41][42][43][44][45][46][47][48][49][50][51][52] Fundamental science 19 53…”

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confidence: 99%

Reporting fidelity in the literature for computer aided design and additive manufacture of implants and guides

Burton

Peel

Eggbeer

2018

Additive Manufacturing

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The aim of this study was to critically evaluate the nature and reporting fidelity of literature about applications of computer aided design (CAD) and metal additive manufacture (AM) to surgical guides and implants. Increasingly, non-specialist designers such as surgeons or prosthetists are partaking in some or all of the design process. To comply with local regulations, it is imperative that quality is ensured during the design process, yet it is rare for literature to report on the design process of medical devices with sufficient detail to allow proper evaluation or reproduction. This study reviewed the CAD/AM literature for implant and guide design, focussing on detailed justifications for design decisions, economic impacts, and production methods. This review showed that the fidelity of reporting in the literature was low; with opportunities to report crucial design decisions, engineering parameters, and how these relate to clinical results being frequently missed. This research proposes the low fidelity in reporting is likely due to a combination of: reporting for different specialisms, resulting in a lack of expert knowledge in certain areas and assumed knowledge in others; commercial sensitivity of design and manufacturing methods; low volume of clinical cases; and a large gap in translating research to clinical applications. This study concluded that higher fidelity in reporting methods are required when discussing the design of AM medical implants, which would allow comparisons between studies, provide evidence to support design quality, and enable evidence-based decision-making.

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“…The first report of a three-dimensionally printed chest wall implant was published in 2013 by Turna and colleagues [2] This ground-breaking implant was a single rigid plate of sternum and ribs, focused mainly on structural reconstruction. A more advanced implant was reported by Aranda and associates in 2015 [3], although articulation was not considered by design in this case.…”

Section: Commentmentioning

confidence: 99%

Functional Chest Wall Reconstruction With a Biomechanical Three-Dimensionally Printed Implant

Moradiellos

Amor

Córdoba

et al. 2017

The Annals of Thoracic Surgery

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Chest wall resection and reconstruction for neoplastic diseases has unique oncologic, structural, and functional challenges. In a young and fit patient with a mediastinal mass and extensive anterior chest wall invasion, purely structural solutions were deemed insufficient. We hereby present a novel three-dimensionally printed patient-specific titanium implant of sternum and ribs. This osteointegrable implant was designed with biomechanical capabilities using a unique "Greek wave" folding pattern. Postoperative dynamic computed tomography showed that the implant allowed for controlled flexing during the respiratory cycle. Three-dimensional printing with biocompatible materials could enable a new generation of chest wall implants strongly focused on functional reconstruction.

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Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

Cited by 44 publications

References 6 publications

Materials and techniques in chest wall reconstruction: a review

Materials and techniques in chest wall reconstruction: a review

Reporting fidelity in the literature for computer aided design and additive manufacture of implants and guides

Functional Chest Wall Reconstruction With a Biomechanical Three-Dimensionally Printed Implant

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