3D printing-guided chest wall reconstruction - a case report and literature review

Large chest wall defects may be challenging to reconstruct and requires consideration of skeletal stabilization. Whilst use of synthetic materials has been described, the risks of infection and implant failure resulting in removal are omnipresent. The vascularized fibula free flap is an autologous alternative. We present the first reported application of 3D-printed patient-matched fibula marking guide to facilitate reconstruction of a large sternal defect with an autologous vascularized fibula free flap. A 56-year-old patient developed paradoxical chest wall movements with chest pain following a partial sternectomy for sternal fibrous dysplasia. The primary defect was reconstructed with a synthetic implant, complicated by infection requiring hardware removal. Cross-sectional imaging confirmed herniation of lung contents through the defect. Virtual surgical planning was undertaken to define the best configuration for available autologous bone options. A single free fibula twice osteotomized and configured into a triangle with 3 segments was chosen to close the defect. A patient-matched fibula marking guide was designed and 3D-printed for intra-operative use, and titanium plates were pre-contoured using a life-sized 3D-printed chest wall model. Surgery proceeded without complications, with reported resolution of symptoms post-operatively. Current literature on 3D printing technology for chest wall reconstruction primarily focuses on synthetic implants rather than autologous tissue transfer. Whilst autologous bone grafting for sternal defects is well described, only three cases have reported the use of vascularized fibular free flap reconstruction. This case demonstrates the feasibility of integrating a 3D-printing workflow in the surgical planning of autologous vascularized sternal reconstruction.