Sternal Reconstruction Using 3D-Printed Titanium Custom-Made Prosthesis for Sternal Dehiscence After Cardiac Surgery
Keywords:sternotomy, sternal dehiscence, reconstruction, titanium, prosthesis, 3D printing
Sternal dehiscence is an important complication that increases mortality and morbidity in cardiac surgery. Titanium plates have been used to reconstruct the chest wall for a long time. However, with the rise of 3D printing technology, a more sophisticated method, is making a breakthrough. Custom-made 3D-printed titanium prostheses are increasingly used in chest wall reconstruction because they allow almost perfect fitting to the patient’s chest wall and lead to good functional and cosmetic results. This report presents a complex anterior chest wall reconstruction using a custom-made titanium 3D-printed implant in a patient with a sternal dehiscence after coronary artery bypass surgery. At first, reconstruction of the sternum was performed using conventional methods, which failed to give adequate results. Finally, a 3D-printed titanium custom-made prosthesis was used for the first time in our center. On the short- and mid-term follow up, good functional results were achieved. In conclusion, this method is suitable for sternal reconstruction after complications in the healing process of median sternotomy wounds in cardiac surgery, especially where other methods do not provide satisfactory results.
Aranda JL, Jiménez MF, Rodríguez M, Varela G. 2015. Tridimensional titanium-printed custom-made prosthesis for sternocostal reconstruction. European Journal of Cardiothoracic Surgery. 48:92-94.
Dzian A, Jozef Ž, Penciak R, Hudák R. 2018. Implantation of a 3D-printed titanium sternum in a patient with a sternal tumor. World Journal of Surgical Oncology. 16:7.
Goldsmith I, Evans PL, Goodrum H, Warbrick-smith J, Bragg T. 2020. Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant. 3D printing in medicie. 6:26.
Heilmann C, Stahl R, Schneider C, Sukhodolya T, Siepe M. 2013. Wound complications after median sternotomy: a single-centre study †. Interactive Cardiovascular and Thoracic Surgery. 16:643-648.
Kaul P. 2017. Sternal reconstruction after post-sternotomy mediastinitis. Journal of Cardiothoracic Surgery. 12:94.
Listewnik MJ, Jedrzejczak T, Majer K, Szylinska A, et al. 2019.Complications in cardiac surgery : An analysis of factors contributing to sternal dehiscence in patients who underwent surgery between 2010 and 2014 and a comparison with the 1990–2009 cohort. Advances in Clinical and Experimental Medicine. 28:913–922.
Sargent LA, Seyfer AE, Hollinger J, Hinson RM, Graeber GM. 1991. The Healing Sternum : A Comparison of Osseous Healing With Wire Versus Rigid Fixation. The Annals of Thoracic Surgery. 52:490-494.
Voss S, Will A, Voss B. 2018. Mid-Term Results After Sternal Reconstruction Using Titanium Plates : Is It Worth It to Plate? The Annals of thoracic surgery. 105:1640–7.
Wang B, Guo Y, Tang J, Yu F. 2019. Three-dimensional custom-made carbon- fiber prosthesis for sternal reconstruction after sarcoma resection. Thoracic Cancer. 10:1500-1502.
Wang W, Liang Z, Yang S, et al. 2020. Three-dimensional ( 3D ) -printed titanium sternum replacement : A case report. Thoracic cancer. 11:3375-3378.
Wen X, Gao S, Feng J, Li S, Gao R, Zhang G. 2018. Chest-wall reconstruction with a customized titanium-alloy prosthesis fabricated by 3D printing and rapid prototyping. Journal of Cardiothoracic Surgery. 13:4.