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For the first time, a patient has received a custom, 3D-printed titanium implant to replace part of his rib cage.
The 54-year-old Spanish man had chest wall sarcoma, a cancerous tumour that grows in the chest wall and, in this case, had grown around his sternum and part of his rib cage. To excise the tumour completely, surgeons also had to remove that part of his skeleton.
The rib cage also is complex, and difficult to replicate. Usually in cases like these, a flat titanium plate is used to reinforce the structure of the rib cage. These aren’t an excellent option: they can come loose, and increase the risk of complications.
But 3D printing is now at a point where it’s a viable option for quickly creating custom implants designed specifically for individual patients.
The patient’s surgical team at Salamanca University Hospital in Salamanca, Spain, commissioned Melbourne, Australia-based medical device company Anatomics to create a customisable titanium implant that could replicate the complicated structure of the sternum and rib cage.
The team used high-resolution CT scans of the patient’s chest to re-create a model of the chest wall and the tumour that was attached to it. This 3D model allowed the surgeon to accurately plan where to cut the patient’s rib cage.
It also allowed Anatomics to create an accurate implant that would match the excision, as well as the individual size and shape of the patient’s chest.
To print the implant, Anatomics sent the file to the CSIRO’s 3D printing laboratory, Lab 22, which houses a AU$1.3 million Arcam printer that prints in metal. This operates using a powerful electron beam, which melts metal powder into a 3D object, layer by fine layer.
"The advantage of 3D printing is its rapid prototyping," CSIRO’s Adam Knight wrote in a blog post. "When you’re waiting for life-saving surgery this is the definitely the order of the day."
Previously, Lab 22 has helped with the manufacture of a 3D-printed titanium heel-bone implant.
Once printed, finished and polished, the implant was couriered to the Salamanca University Hospital, where it was implanted into the patient’s chest. It has now been two weeks since the surgery, and the patient has been discharged is recovering well.