Dynamic 3D printed titanium copy prosthesis: a novel design for large chest wall resection and reconstruction

The first known chest wall resection was reported in the 18th century (1). Up to this day, many different reconstructive techniques have been described. However, reconstruction of the bony chest wall is controversial. Decision about which defects have to be reconstructed and what is the optimal prosthetic material is a disputed issue (2-8). However, there is agreement that high rates of postoperative complications associated to resection is a common concerning point. Indeed, the overall complications rate has been found above 40% (9) and 30-day mortality from 0% to 17% (10-16). Respiratory complications, continue to be the most frequent, and are reported in 20% to 24% of the patients (1). Only sporadic reports focusing on quality of life and postoperative pulmonary function exist (17,18). Although, there are no enough data to draw firm conclusions, is not unreasonable to imagine the possible relation between functional results and rigidity associated to different reconstructive techniques, especially for large size defects. Functional results, may be determinant for postoperative clinical outcomes and quality of life. In this case, starting from preoperative computerized tomography (CT), the ribs involved were delimited and resection was planned. Based on 3D titanium-printed technology, in a forward step from previous reported custom-made prosthesis, we designed an exact copy of this part endowing a novel dynamic system for sternochondral junctions. Hence, the most anatomical and physiological prosthesis ever made to this day was implanted in this patient. Clinical and functional outcomes were examined