A novel approach to pediatric chest wall reconstruction using a 3D-printed biodynamic prosthesis: A case report

Introduction

Chest wall reconstruction in children continues to be a challenging undertaking, aiming to restore both form and function. An optimal chest wall reconstruction material has not been identified that would provide dynamic chest function and would ideally avoid potential long-term sequelae.

Case presentation

A 15-year-old female with Li Fraumeni syndrome and a history of hepatic rhabdomyosarcoma presented with increasing left back and left scapular pain initially attributed to her known scoliosis. Computed tomography revealed a 12 x 6 × 7 cm mass encasing ribs 3–5 extending into the left chest wall and axilla. Image-guided biopsy confirmed a high-grade osteosarcoma without extra-thoracic metastatic disease. She underwent neoadjuvant chemotherapy after which a three-dimensional (3D) anatomic model of the tumor was printed using the post-therapy imaging reconstruction. The surgical team collaborated with Osteobionix (Osteobionics S.L., Santa Lucia de Tirajana, Spain) to create a patient-specific dynamic chest wall reconstruction implant, based on 3D modeling of the planned resection zone. The final implant was 3D printed with a titanium alloy using electron-beam manufacturing technology, sterilized prior to implantation. She underwent left thoracotomy and rib resection with prosthesis fixation to the T3, T4, and T5 vertebral bodies posteriorly and to the sternum anteriorly. More than2 years after the operation, she is doing well without evidence of recurrent disease. She has an excellent cosmetic result, there has been no progression of her scoliosis, and she has returned to competitive sports.

Conclusion

Our titanium-based 3D-printed, patient-specific implant seems to be a valuable option for the reconstruction of the chest wall in children who require an extensive chest wall resection.