Functional chest wall reconstruction using dynamic prosthesis. Is 3D printing technology our new allied?

INTRODUCTION AND PURPOSE
Chest wall resection and reconstruction represents an oncologic, structural and functional challenges (1, 2). The reconstruction must restore skeletal stability to protect vital structures, preserve respiratory function, restore anatomical cavities and upper extremities support (1-4). Therefore, the ultimate goal is to achieve the relative stability inherent in a dynamic chest wall while preventing an unstable thorax. Thus, semi-rigid fixation methods are superior to rigid fixation methods that do not allow physiological movement of the chest wall (3).
The objective of this work is to present our experience in chest wall reconstruction using customized 3D-printed dynamic prosthesis, with the aim of restoring protection, function and elasticity to the thorax.


METHODS
Between September 2022 and May 2023, five patients with a primary or metastatic chest wall tumor underwent resection and reconstruction surgery in our Hospital.
In all cases, immediate composed reconstruction was performed using a biological mesh, a customized titanium 3D-printed dynamic prosthesis, and a pedicled or free flap for coverage.
The average follow-up time was 8 months.


RESULTS
There were no postoperative adverse events.
Despite the extensive resection of the sternum and/or ribs, no patient presented paradoxical chest wall movements postoperatively or during follow-up.
All patients presented a restrictive pattern in the pulmonary function tests. However, it was well managed with physiotherapy and resulted in adequate respiratory function.
Stable coverage, protection of the structures and an adequate chest wall contour were also achieved.


CONCLUSIONS
The goals of successful chest wall reconstruction include protecting the intrathoracic organs, restoring chest wall stability and thus preserving respiratory function (1-5).
Preoperative planning and 3D printing technology make it possible to design the exact dimensions of the implant, adapting it to the defect in each case (4).
Compared to classic reconstruction methods, the dynamic prosthesis provides semi-rigid fixation with its three-dimensional 'Greek wave' design. This design allows for the recreation of chest wall compliance while restoring skeletal stability, protecting the structures and maintaining the shape (2).
The use of a biological mesh allows for the separation of the lungs and other structures from the implant and helps seal the pleural cavity (2, 3).
Additionally, it is essential to provide high-quality and stable coverage by using flaps to protect the bioprosthetic materials and reduce medium to long-term complications (3, 4).


BIBLIOGRAPHY
1. Goldsmith I. Chest wall reconstruction with 3D printing: Anatomical and functional considerations. Innovations (Phila). 2022;17(3):191–200.
2. Moradiellos J, Amor S, Córdoba M, Rocco G, Vidal M, Varela A. Functional chest wall reconstruction with a biomechanical three-dimensionally printed implant. Ann Thorac Surg. 2017;103(4):e389–e391.
3. Isaac KV, Elzinga K, Buchel EW. The best of chest wall reconstruction: Principles and clinical application for complex oncologic and sternal defects. Plast Reconstr Surg. 2022;149(3):547e–562e.
4. Sanna S, Brandolini J, Pardolesi A, et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg. 2017;3:95.
5. Goldsmith I, Dovgalski L, Evans PL. 3D printing technology for chest wall reconstruction with a sternum-ribs-cartilage titanium implant: From ideation to creation. Innovations (Phila). 2023;18(1):67–72.

Reconstructive

PSTM 2024