Three-Dimensional Printing for Chest Wall Reconstruction in Thoracic Surgery: Building on Experience

Smelt, Jeremy; Pontiki, Antonia; Jahangiri, Marjan; Rhode, Kawal; Nair, Arjun; Billè, Andrea

doi:10.1055/s-0039-1678611

Cited by 23 publications

(23 citation statements)

References 25 publications

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“…This includes synthetic meshes, bioprosthetic materials, stainless-steel bars, osseo-integrated titanium systems, autografts, homografts or porcine or bovine xenografts. In 2020, Smelt et al described the successful application of personalized three-dimensional (3D)printed chest wall prostheses made of methylmetacrylate covered by expanded polytetrafluoroethylene for patients undergoing chest wall resection and reconstruction (30). However, due to residual growth and development, the choice of the optimal material is a major consideration in the pediatric and adolescent population.…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary Radical “En-Bloc” Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents

et al. 2021

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Introduction: Ewing sarcomas of the chest wall, historically known as “Askin tumors” represent highly aggressive pediatric malignancies with a reported 5-year survival ranging only between 40 and 60% in most studies. Multimodal oncological treatment according to specific Ewing sarcoma protocols and radical “en-bloc” resection with simultaneous chest wall repair are key factors for long-term survival. However, the surgical complexity depends on tumor location and volume and potential infiltrations into lung, pericardium, diaphragm, esophagus, spine and major vessels. Thus, the question arises, which surgical specialties should join their comprehensive skills when approaching a child with Ewing sarcoma of the chest wall.Patients and Methods: All pediatric patients with Ewing sarcomas of the chest wall treated between 1990 and 2020 were analyzed focusing on complete resection, chest wall reconstruction, surgical complications according to Clavien-Dindo (CD) and survival. Patients received neo-adjuvant chemotherapy according to the respective Ewing sarcoma protocols. Depending on tumor location and organ infiltration, a multi-disciplinary surgical team was orchestrated to perform radical en-bloc resection and simultaneous chest wall repair.Results: Thirteen consecutive patients (seven boys and six girls) were included. Median age at presentation was 10.9 years (range 2.2–21 years). Neo-adjuvant chemotherapy (n = 13) and irradiation (n = 3) achieved significant reduction of the median tumor volume (305.6 vs. 44 ml, p < 0.05). En-bloc resection and simultaneous chest wall reconstruction was achieved without major complications despite multi-organ involvement. Postoperatively, one patient with infiltration of the costovertebral joint and laminectomy required surgical re-intervention (CD IIIb). 11/13 patients were treated with clear resections margins (R1 resection in one patient with infiltration of the costovertebral joint and marginal resection <1 mm in one child with multiple pulmonary metastases). All patients underwent postoperative chemotherapy; irradiation was performed in four children. Two deaths occurred 18 months and 7.5 years after diagnosis, respectively. Median follow-up for the remaining patients was 8.8 years (range: 0.9–30.7 years). The 5-year survival rate was 89% and the overall survival 85%.Conclusion: EWING specific oncological treatment and multi-disciplinary surgery performing radical en-bloc resections and simultaneous chest wall repair contribute to an improved survival of children with Ewing sarcoma of the chest wall.

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Section: Discussionmentioning

confidence: 99%

Interdisciplinary Radical “En-Bloc” Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents

et al. 2021

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“…10 In contrast, rigidity is added with grafts made of methyl acrylate. 11 The rigidity of a chest wall graft is reported to be a central parameter with respect to avoiding post-operative complications. 12 Furthermore, the materials must have the ability to integrate into the adjacent tissue quickly, to be vascularized well, and are at best degradable without releasing toxic by-products.…”

Section: Introductionmentioning

confidence: 99%

Hybrid nanocomposite as a chest wall graft with improved vascularization by copper oxide nanoparticles

et al. 2022

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Chest wall repair can be necessary after tumor resection or chest injury. In order to cover or replace chest wall defects, autologous tissue or different synthetic materials are commonly used, among them the semi-rigid gold standard Gore-Tex® and prolene meshes. Synthetic tissues include composite materials with an organic and an inorganic component. On the basis of previously reported hybrid nanocomposite poly-lactic-co-glycolic acid amorphous calcium phosphate nanocomposite (PLGA/aCaP), a CuO component was incorporated to yield (60%/35%/5%). This graft was tested in vitro by seeding with murine adipose-derived stem cells (ASCs) for cell attachment and migration. The graft was compared to PLGA/CaCO3 and PLGA/hydroxyapatite, each providing the inorganic phase as nanoparticles. Further characterization of the graft was performed using scanning electron microscopy. Furthermore, PLGA/aCaP/CuO was implanted as a chest wall graft in mice. After 4 weeks, total cell density, graft integration, extracellular matrix components such as fibronectin and collagen I, the cellular inflammatory response (macrophages, F4/80 and lymphocytes, CD3) as well as vascularization (CD31) were quantitatively assessed. The nanocomposite PLGA/aCaP/CuO showed a good cell attachment and cells migrated well into the pores of the electrospun meshes. Cell densities did not differ between PLGA/aCaP/CuO and PLGA/CaCO3 or PLGA/hydroxyapatite, respectively. When applied as a chest wall graft, adequate stability for suturing into the thoracic wall could be achieved. Four weeks post-implantation, there was an excellent tissue integration without relevant fibrotic changes and a predominating collagen I matrix deposition within the graft. Slightly increased inflammation, reflected by increased infiltration of macrophages could be observed. Vascularization of the graft was significantly enhanced when compared with PLGA/aCaP (no CuO). We conclude that the hybrid nanocomposite PLGA/aCaP/CuO is a viable option to be used as a chest wall graft. Surgical implantation of the material is feasible and provides stability and enough flexibility. Proper tissue integration and an excellent vascularization are characteristics of this biodegradable material.

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“…The promotion of three-dimensional (3D) reconstruction technology greatly meets the needs of clinicians to a certain extent. This technology has been widely used in the human body, especially in hepatobiliary surgery, breast surgery, maxillofacial surgery, and bone surgery ( 1 – 3 ). In 1990, the earliest application in the liver was proposed by Hashimoto et al ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Feasibility Study of Intelligent Three-Dimensional Accurate Liver Reconstruction Technology Based on MRI Data

Cao

Dong

et al. 2022

Front. Med.

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Intelligent three-dimensional (3D) reconstruction technology plays an important role in the diagnosis and treatment of diseases. It has been widely used in assisted liver surgery. At present, the 3D reconstruction information of liver is mainly obtained based on CT enhancement data. It has also been commercialized. However, there are few reports on the display of 3D reconstruction information of the liver based on MRI. The purpose of this study is to propose a new idea of intelligent 3D liver reconstruction based on MRI technology and verify its feasibility. Two different liver scanning data (CT and MRI) were selected from the same batch of patients at the same time (patients with a time interval of no more than two weeks and without surgery). The results of liver volume, segmentation, tumor, and simulated surgery based on MRI volume data were compared with those based on CT data. The results show that the results of 3D reconstruction based on MRI data are highly consistent with those based on CT 3D reconstruction. At the same time, in addition to providing the information provided by CT 3D reconstruction, it also has its irreplaceable advantages. For example, multi-phase (early, middle and late arterial, hepatobiliary, etc.) scanning of MRI technology can provide more disease information and display of biliary diseases. In a word, MRI technology can be used for 3D reconstruction of the liver. Hence, a new feasible and effective method to show the liver itself and its disease characteristics is proposed.

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Three-Dimensional Printing for Chest Wall Reconstruction in Thoracic Surgery: Building on Experience

Cited by 23 publications

References 25 publications

Interdisciplinary Radical “En-Bloc” Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents

Interdisciplinary Radical “En-Bloc” Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents

Hybrid nanocomposite as a chest wall graft with improved vascularization by copper oxide nanoparticles

Feasibility Study of Intelligent Three-Dimensional Accurate Liver Reconstruction Technology Based on MRI Data

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