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.

中文翻译：

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特定患者的钛植入物的设计，增材制造和临床应用，以解剖方式重建大型胸壁缺损

目的

切除后重建大型肿瘤缺损的胸壁是具有挑战性的。传统管理涉及使用不同的材料，外科医生会在术中创造性地塑造其形状，以恢复切除的解剖结构。这是耗时的，难以成型，并引起一些复杂性，例如错位或自相矛盾的运动。这项研究旨在介绍新型定制的三维（3D）激光熔融钛合金植入物的开发和临床植入，该植入物可重建大型胸壁切除并维持胸廓的完整性。

设计/方法/方法

描述了新型植入物的整个开发过程：设计规范，计算机断层扫描（CT）扫描操作，3D计算机辅助设计（CAD），快速原型制作，最终制造和临床植入。工程师和外科医生之间的多学科合作指导了迭代设计过程。

发现

植入物提供了出色的美学和功能效果。手术前对植入物的虚拟计划和生产减少了手术时间和不确定性。它还提高了安全性和准确性。按照虚拟计划切除后，植入物很好地定位在患者的解剖结构上。植入后六个月，没有与植入物有关的疼痛，感染，脱位或自相矛盾的并发症。这项技术为植入物的生产提供了快速的交货时间，这对于肿瘤治疗至关重要。

研究局限/意义

需要更多病例并进行长期随访，以确认和量化该手术的益处；还需要进一步的研究来设计一种能够更好地模仿胸壁生物力学并防止植入物并发症的解决方案。

创意/价值

作者介绍了一种新颖的定制胸腔植入物，该植入物可令人满意地重建大的胸壁缺损，并在三周内开发并植入，可解决快速增长的软骨肉瘤。此外，作者将其开发过程详细描述为设计指南，讨论了潜在的改进和关键的设计注意事项，以便可以将本研究复制用于将来的案例。