Three-dimensional custom-made carbon-fiber prosthesis for sternal reconstruction after sarcoma resection

Abstract

Radical resection is the preferred therapy for primary malignant sternal tumors. Sternal reconstruction is required to guarantee the best preservation of respiratory mechanics, and adequate mediastinal protection and acceptable cosmetic results after extensive tumor resection. A wide variety of methods and materials have been described for sternal reconstruction. Titanium implants are preferred by many surgeons because of their optimal features. However, the smooth surface of the metal prostheses does not facilitate the inward growth of the tissue, and the high density of metal can block the X-ray and cause adverse effects on postoperative imaging and radiotherapy. Therefore, in this article we present a case of sternal reconstruction by means of a three dimensional (3D) custom-made carbon-fiber prosthesis following extensive resection of a sternal synovial sarcoma. The microporous structure on the surface of the carbon fiber composite material facilitates the inward growth of the tissue. Low density (1.5 g/cm³ ) of carbon-fiber implant will not block the X-ray and eliminates the adverse effects caused by metal material of postoperative imaging and radiotherapy. The 3D custom-made carbon-fiber prosthesis matched the thoracic defect perfectly and the chest wall reconstruction was stable for more than 24 months.

Keywords: Carbon-fiber prosthesis; chest wall reconstruction; custom-made prosthesis; sternal sarcoma.

Figure 1

(a,b) Initial computed tomography (CT) scan of the thorax. White arrow indicates the sternal tumor. (b) 3D reconstruction of the chest skeleton. (c–e). Initial positron emission tomography‐computed tomography (PET‐CT) scan of different sections showed a 4 cm visible glucose metabolism increased sternal mass (maximum standardized uptake value = 42). White arrow indicates the glucose metabolism increased mass.

Figure 2

(a) The tumor excised during the surgery and the 3D custom‐made carbon‐fiber implant. (b) The custom prosthesis implanted into the sternal defect with the cruciate ligament sutures and steel wires. (c) 3D reconstruction of chest skeleton with the CT data six months after surgery. White arrow indicates the custom‐made implant.