scholarly journals Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Ira Goldsmith ◽  
Peter Llewelyn Evans ◽  
Heather Goodrum ◽  
James Warbrick-Smith ◽  
Thomas Bragg
Keyword(s):  
Titanium Alloy ◽  
Chest Wall ◽  
Computer Aided Design ◽  
Extent Of Resection ◽  
Patient Specific ◽  
Chest Wall Resection ◽  
Soft Tissue Reconstruction ◽  
Large Defect ◽  
Paradoxical Movement ◽  
Custom Made

Abstract Background Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant. Method To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient’s chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially. Results Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant. Conclusion Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.

Design, additive manufacture and clinical application of a patient-specific titanium implant to anatomically reconstruct a large chest wall defect

2021 ◽  
Vol 27 (2) ◽  
pp. 304-310
Author(s):  
Alba Gonzalez Alvarez ◽  
Peter Ll. Evans ◽  
Lawrence Dovgalski ◽  
Ira Goldsmith
Keyword(s):  
Chest Wall ◽  
Development Process ◽  
Patient Specific ◽  
Computer Assisted ◽  
Design Guideline ◽  
Wall Defect ◽  
Content Type ◽  
Chest Wall Defect ◽  
Paradoxical Movement ◽  
Custom Made

Purpose Chest wall reconstruction of large oncological defects following resection is challenging. Traditional management involves the use of different materials that surgeons creatively shape intraoperatively to restore the excised anatomy. This is time-consuming, difficult to mould into shape and causes some complications such as dislocation or paradoxical movement. This study aims to present the development and clinical implantation of a novel custom-made three-dimensional (3D) laser melting titanium alloy implant that reconstructs a large chest wall resection and maintains the integrity of the thoracic cage. Design/methodology/approach The whole development process of the novel implant is described: design specifications, computed tomography (CT) scan manipulation, 3D computer-assisted design (CAD), rapid prototyping, final manufacture and clinical implantation. A multidisciplinary collaboration in between engineers and surgeons guided the iterative design process. Findings The implant provided excellent aesthetical and functional results. The virtual planning and production of the implant prior to surgery reduced surgery time and uncertainty. It also improved safety and accuracy. The implant sited nicely on the patient anatomy after resection following the virtual plan. At six months following implantation, there were no implant-related complications of pain, infection, dislocation or paradoxical movement. This technique offered a fast lead-time for implant production, which is crucial for oncological treatment. Research limitations/implications More cases and a long-term follow-up are needed to confirm and quantify the benefits of this procedure; further research is also required to design a solution that better mimics the chest wall biomechanics while preventing implant complications. Originality/value The authors present a novel custom thoracic implant that provided a satisfactory reconstruction of a large chest wall defect, developed and implanted within three weeks to address a fast-growing chondrosarcoma. Furthermore, the authors describe its development process in detail as a design guideline, discussing potential improvements and critical design considerations so that this study can be replicated for future cases.

scholarly journals An Innovative and Cost-Advantage CAD Solution for Cubitus Varus Surgical Planning in Children

2021 ◽  
Vol 11 (9) ◽  
pp. 4057
Author(s):  
Leonardo Frizziero ◽  
Gian Maria Santi ◽  
Christian Leon-Cardenas ◽  
Giampiero Donnici ◽  
Alfredo Liverani ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Low Cost ◽  
Cost Effective ◽  
Varus Deformity ◽  
Patient Specific ◽  
Cubitus Varus ◽  
Surgical Guide ◽  
Traditional Procedure ◽  
Custom Made ◽  
Patient Specific Instruments

The study of CAD (computer aided design) modeling, design and manufacturing techniques has undergone a rapid growth over the past decades. In medicine, this development mainly concerned the dental and maxillofacial sectors. Significant progress has also been made in orthopedics with pre-operative CAD simulations, printing of bone models and production of patient-specific instruments. However, the traditional procedure that formulates the surgical plan based exclusively on two-dimensional images and interventions performed without the aid of specific instruments for the patient and is currently the most used surgical technique. The production of custom-made tools for the patient, in fact, is often expensive and its use is limited to a few hospitals. The purpose of this study is to show an innovative and cost-effective procedure aimed at prototyping a custom-made surgical guide for address the cubitus varus deformity on a pediatric patient. The cutting guides were obtained through an additive manufacturing process that starts from the 3D digital model of the patient’s bone and allows to design specific models using Creo Parametric. The result is a tool that adheres perfectly to the patient’s bone and guides the surgeon during the osteotomy procedure. The low cost of the methodology described makes it worth noticing by any health institution.

scholarly journals Innovative Design Methodology for Patient-Specific Short Femoral Stems

Materials ◽  
2022 ◽  
Vol 15 (2) ◽  
pp. 442
Author(s):  
William Solórzano-Requejo ◽  
Carlos Ojeda ◽  
Andrés Díaz Lantada
Keyword(s):  
Computer Aided Design ◽  
Design Methodology ◽  
Patient Specific ◽  
Bone Stock ◽  
Innovative Design ◽  
Hip Prostheses ◽  
Custom Made ◽  
In Silico Studies ◽  
Femoral Stems ◽  
Short Stems

The biomechanical performance of hip prostheses is often suboptimal, which leads to problems such as strain shielding, bone resorption and implant loosening, affecting the long-term viability of these implants for articular repair. Different studies have highlighted the interest of short stems for preserving bone stock and minimizing shielding, hence providing an alternative to conventional hip prostheses with long stems. Such short stems are especially valuable for younger patients, as they may require additional surgical interventions and replacements in the future, for which the preservation of bone stock is fundamental. Arguably, enhanced results may be achieved by combining the benefits of short stems with the possibilities of personalization, which are now empowered by a wise combination of medical images, computer-aided design and engineering resources and automated manufacturing tools. In this study, an innovative design methodology for custom-made short femoral stems is presented. The design process is enhanced through a novel app employing elliptical adjustment for the quasi-automated CAD modeling of personalized short femoral stems. The proposed methodology is validated by completely developing two personalized short femoral stems, which are evaluated by combining in silico studies (finite element method (FEM) simulations), for quantifying their biomechanical performance, and rapid prototyping, for evaluating implantability.

scholarly journals Reconstruction of Post-Traumatic Orbital Defects and Deformities with Custom-Made Patient-Specific Implants: Evaluation of the Efficacy and Clinical Outcome

2019 ◽  
Vol 3 (1) ◽  
pp. s-0039-1685505 ◽  
Author(s):  
Yurii Chepurnyi ◽  
Denis Chernogorskyi ◽  
Oksana Petrenko ◽  
Andrii Kopchak
Keyword(s):  
Computer Aided Design ◽  
Visual Fields ◽  
Infectious Complications ◽  
Patient Specific ◽  
Reconstructive Procedures ◽  
Patient Specific Implants ◽  
Custom Made ◽  
Computer Aided ◽  
Post Traumatic ◽  
Orbital Defects

The main purpose of this article is to evaluate the efficacy of patient-specific implants (PSI) in treatment of patients with post-traumatic orbital defects and deformities. Twenty-three patients with post-traumatic orbital defects and deformities, who underwent subsequent reconstructive procedures using PSI, were included in the study. All the patients were examined according to the standard algorithm involving the local status examination, vision assessment, and computed tomography before and after surgery. The study findings show neither postoperative infectious complications nor decreased visual acuity or loss of visual fields. Functional disorders resolved in 65.2% of cases 1 month after the surgical intervention and in 86.96% of patients within a 3-month term. Positive aesthetic outcomes were seen in 95.7% of cases. Reconstruction with computer-aided design/computer-aided manufactured PSI is an effective procedure that allows accurate restoring of the complex orbital anatomy.

scholarly journals Accuracy of an automated three-dimensional technique for the computation of femoral angles in dogs

2019 ◽  
Vol 185 (14) ◽  
pp. 443-443 ◽  
Author(s):  
Federico Longo ◽  
Gianpaolo Savio ◽  
Barbara Contiero ◽  
Roberto Meneghello ◽  
Gianmaria Concheri ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Three Dimensional ◽  
Deformity Correction ◽  
Patient Specific ◽  
3D Scanner ◽  
Measurement Variability ◽  
Reliable Technique ◽  
Gold Standard Method ◽  
Femoral Torsion ◽  
Custom Made

Aims: The purpose of the study was to evaluate the accuracy of a three-dimensional (3D) automated technique (computer-aided design (aCAD)) for the measurement of three canine femoral angles: anatomical lateral distal femoral angle (aLDFA), femoral neck angle (FNA) and femoral torsion angle.Methods:Twenty-eight femurs equally divided intotwo groups (normal and abnormal) were obtained from 14 dogs of different conformations (dolicomorphic and chondrodystrophicCT scans and 3D scanner acquisitions were used to create stereolithographic (STL) files , which were run in a CAD platform. Two blinded observers separately performed the measurements using the STL obtained from CT scans (CT aCAD) and 3D scanner (3D aCAD), which was considered the gold standard method. C orrelation coefficients were used to investigate the strength of the relationship between the two measurements.Results: A ccuracy of the aCAD computation was good, being always above the threshold of R2 of greater than 80 per cent for all three angles assessed in both groups. a LDFA and FNA were the most accurate angles (accuracy >90 per cent).Conclusions: The proposed 3D aCAD protocol can be considered a reliable technique to assess femoral angle measurements in canine femur. The developed algorithm automatically calculates the femoral angles in 3D, thus considering the subjective intrinsic femur morphology. The main benefit relies on a fast user-independent computation, which avoids user-related measurement variability. The accuracy of 3D details may be helpful for patellar luxation and femoral bone deformity correction, as well as for the design of patient- specific, custom-made hip prosthesis implants.

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

2013 ◽  
Vol 18 (2) ◽  
pp. 234-236 ◽  
Author(s):  
Akif Turna ◽  
Kuthan Kavakli ◽  
Ersin Sapmaz ◽  
Hakan Arslan ◽  
Hasan Caylak ◽  
...  
Keyword(s):  
Chest Wall ◽  
Titanium Implant ◽  
Anterior Chest Wall ◽  
Patient Specific ◽  
Chest Wall Resection

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

2019 ◽  
Vol 68 (04) ◽  
pp. 352-356
Author(s):  
Jeremy Smelt ◽  
Antonia Pontiki ◽  
Marjan Jahangiri ◽  
Kawal Rhode ◽  
Arjun Nair ◽  
...  
Keyword(s):  
Chest Wall ◽  
Locally Advanced ◽  
Three Dimensional ◽  
Cost Effective ◽  
Chest Wall Reconstruction ◽  
Advanced Lung Cancer ◽  
Patient Specific ◽  
Chest Wall Resection ◽  
En Bloc ◽  
3D Print

Objectives Patients undergoing surgery for locally advanced lung cancer involving the chest wall require anatomical lung with extensive en-bloc chest wall resection and appropriate reconstruction.In this proof-of-concept study, we aimed to produce personalized three-dimensional (3D)-printed chest wall prosthesis for a patient undergoing chest wall resection and reconstruction using clinically obtained computed tomography (CT) data. Methods Preoperative CT scans of three patients undergoing chest wall resection were analyzed and the areas of resection segmented. This was then used to produce a 3D print of the chest wall and a silicone mold was created from the model. This mold was sterilized and used to produce methyl methacrylate prostheses which were then implanted into the patients. Results Three patients had their chest wall reconstructed using this technique to produce a patient specific prosthesis. There were no early complications or deaths. Conclusions It is possible to use 3D printing to produce a patient specific chest wall reconstruction for patients undergoing chest wall resection for malignancy that is cost-effective. This chest wall is thought to provide stability in the form of prosthetic ribs as well compliance in the form of an expanded polytetrafluoroethylene patch. Further research is required to measure chest wall compliance during the respiratory cycle and long-term follow-up from this method.

scholarly journals Computer-Aided Design and Manufacturing Technology for Identification of Optimal Nuss Procedure and Fabrication of Patient-Specific Nuss Bar for Minimally Invasive Surgery of Pectus Excavatum

2018 ◽  
Vol 9 (1) ◽  
pp. 42 ◽  
Author(s):  
Yoon-Jin Kim ◽  
Jin-Young Heo ◽  
Ki-Hyun Hong ◽  
Hoseok I ◽  
Beop-Yong Lim ◽  
...  
Keyword(s):  
Chest Wall ◽  
Computer Aided Design ◽  
Pectus Excavatum ◽  
Optimal Operation ◽  
Numerical Control ◽  
Patient Specific ◽  
Nuss Procedure ◽  
Computer Aided ◽  
Aided Design ◽  
Design Drawing

The Nuss procedure is one of the most widely used operation techniques for pectus excavatum (PE) patients. It attains the normal shape of the chest wall by lifting the patient’s chest wall with the Nuss bar. However, the Nuss bar is for the most part bent by a hand bender according to the patient’s chest wall, and this procedure causes various problems such as the failure of the operation and a decreased satisfaction of the surgeon and patient about the operation. To solve this problem, we proposed a method for deriving the optimal operation result by designing patient-specific Nuss bars through computer-aided design (CAD) and computer-aided manufacturing (CAM), and by performing auto bending based on the design. In other words, a three-dimensional chest wall model was generated using the computed tomography (CT) image of a pectus excavatum patient, and an operation scenario was selected considering the Nuss bar insertion point and the post-operative chest wall shape. Then, a design drawing of the Nuss bar that could produce the optimal operation result was derived from the operation scenario. Furthermore, after a computerized numerical control (CNC) bending machine for the Nuss bar bending was constructed, the Nuss bar prototype was manufactured based on the derived design drawing of the Nuss bar. The Nuss bar designed and manufactured with the proposed method has been found to improve the Haller index (HI) of the pectus excavatum patient by approximately 37% (3.14 before to 1.98 after operation). Moreover, the machining error in the manufacturing was within ±5% compared to the design drawing. The method proposed and verified in this study is expected to reduce the failure rate of the Nuss procedure and significantly improve the satisfaction of the surgeon and patient about the operation.

Use of pedicled latissimus dorsi flap in anterior chest wall reconstruction

2021 ◽  
Vol 14 (1) ◽  
pp. e239890
Author(s):  
Rini Vyas ◽  
Rebecca Rollett ◽  
Nakul Patel ◽  
Sridhar Rathinam
Keyword(s):  
Soft Tissue ◽  
Chest Wall ◽  
Latissimus Dorsi ◽  
Anterior Chest Wall ◽  
Chest Wall Reconstruction ◽  
Latissimus Dorsi Flap ◽  
Chest Wall Resection ◽  
Soft Tissue Reconstruction ◽  
Form And Function ◽  
Tissue Reconstruction

Successful surgical management of chest wall tumours relies on extensive chest wall resection with adequate margins. In large complex tumours, return to form and function is determined by appropriate skeletal and soft tissue reconstruction of the chest wall defect. We report an original case of a large 11×16×3 cm ulcerative basosquamous carcinoma of the anterior chest wall. Soft tissue reconstruction was performed with a unilateral pedicled latissimus dorsi flap. A multidisciplinary approach between thoracic and plastic surgeons was used in the planning, intraoperative and follow-up periods. This case highlights a good long-term functional and cosmetic outcome in complex chest wall reconstruction as a result of successful cross-specialty collaboration.

Multiple segment total en bloc vertebrectomy and chest wall resection in a dog with an invasive myxosarcoma

2020 ◽  
Vol 8 (2) ◽  
pp. e001033 ◽  
Author(s):  
Julius M Liptak ◽  
Stan Veytsman ◽  
Shanna Kerr ◽  
Jan Klasen
Keyword(s):  
Chest Wall ◽  
Latissimus Dorsi ◽  
Muscle Flap ◽  
Latissimus Dorsi Muscle ◽  
Thoracic Wall ◽  
Patient Specific ◽  
Chest Wall Resection ◽  
En Bloc ◽  
Latissimus Dorsi Muscle Flap ◽  
Dorsi Muscle

A 9.5-year-old, 22.6 kg, castrated male mixed breed dog was diagnosed with a paravertebral myxosarcoma invading into the T9–T11 vertebrae and dorsal left-sided thoracic wall. A total multisegment vertebrectomy of T9–T12 and chest wall resection of the left 8th–12th ribs were performed to resect the tumour en bloc. A patient-specific, three-dimensional implant was designed and printed to reconstruct the defect in the vertebral column following resection of the tumour. This implant was supplemented with four 2.7 mm string-of-pearl plates. The chest wall defect was reconstructed with a latissimus dorsi muscle flap. Postoperative complications included neurological deterioration, and necrosis of the latissimus dorsi muscle flap resulting in marked pneumothorax and cardiorespiratory arrest 17 days postoperatively.

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