Chest wall stabilization following hemi-sternectomy assisted by 3D printed model.

Abstract

The incidence of deep sternal wound infection post-sternotomy is 1.6%. Treatment with sternectomy or hemi-sternectomy can result in exposed thoracic organs, chest wall and shoulder girdle instability, reduced upper extremity function and disability. Various materials and soft tissue techniques are available for chest wall reconstruction; however, the use of a 3D-printed model to facilitate preoperative bending of titanium plating systems for sternal reconstruction has not been previously reported. A 51-year-old female presented to the plastic surgery clinic with a history of coronary artery bypass grafting complicated by sternal osteomyelitis. A left hemi-sternectomy was performed to treat the infection, after which the patient developed chronic pain and shoulder instability. The patient was referred to plastic surgery to consider options for combined sternal stabilization and flap coverage. A polyamide 3D-printed model of the sternum and ribcage was produced, followed by pre-operative bending of sternal-spanning long rib plates for use in the operating room. The model and the pre-bent plates were sterilized and brought to surgery. After elevation of pectoralis muscle flaps and exposure, the pre-bent plates were directly applied to the rib cage with minimal modification, thus obtaining the pre-planned reduction of the sternum/ribcage and saving a significant amount of time in the operating room. The patient made a good recovery from the operation with significant improvement of chest wall stability, improvement of shoulder function, and a decrease in chest discomfort. This report details the application of 3D printing to increase the precision and efficiency of chest wall stabilization.