Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

Mind the gap! Interdisciplinary approach to anterior chest wall reconstruction after total sternectomy

BACKGROUND

There are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery.

METHODS

Four patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center.

RESULTS

All patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up.

CONCLUSIONS

We recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry.

Use of Biomaterials in 3D Printing as a Solution to Microbial Infections in Arthroplasty and Osseous Reconstruction

The incidence of microbial infections in orthopedic prosthetic surgeries is a perennial problem that increases morbidity and mortality, representing one of the major complications of such medical interventions. The emergence of novel technologies, especially 3D printing, represents a promising avenue of development for reducing the risk of such eventualities. There are already a host of biomaterials, suitable for 3D printing, that are being tested for antimicrobial properties when they are coated with bioactive compounds, such as antibiotics, or combined with hydrogels with antimicrobial and antioxidant properties, such as chitosan and metal nanoparticles, among others. The materials discussed in the context of this paper comprise beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxyapatite, lithium disilicate glass, polyetheretherketone (PEEK), poly(propylene fumarate) (PPF), poly(trimethylene carbonate) (PTMC), and zirconia. While the recent research results are promising, further development is required to address the increasing antibiotic resistance exhibited by several common pathogens, the potential for fungal infections, and the potential toxicity of some metal nanoparticles. Other solutions, like the incorporation of phytochemicals, should also be explored. Incorporating artificial intelligence (AI) in the development of certain orthopedic implants and the potential use of AI against bacterial infections might represent viable solutions to these problems. Finally, there are some legal considerations associated with the use of biomaterials and the widespread use of 3D printing, which must be taken into account.

Pedicled myocutaneous flap transplantation for a large chest wall defect with infection in a 72-year-old female

Background

In the realm of thoracic surgery, addressing chest wall defects accompanied by infections remains a formidable task. Despite the availability of a spectrum of surgical options, attaining clinical resolution is particularly challenging in intricate cases involving extensive chest wall defects in elderly patients. Thorough debridement followed by the utilization of autologous tissue for repair and reconstruction has emerged as a prevalent approach in current clinical practice.

Case presentation

Herein, we present a 72-year-old female patient with a large chest wall defect and infection. She has experienced left breast cancer surgery, multi cycle radiotherapy and chemotherapy. Nine months ago, there was yellow purulent fluid in the left chest wall. She had undergone debridement in other hospital, and the treatment effect was poor. At our hospital, Chest computed tomography (CT) imaging revealed a soft tissue anomaly on the left side of the chest wall, along with partial rib bone deterioration. Considering the patient's clinical presentation and radiological findings, a tentative diagnosis of an infected chest wall defect and chronic osteomyelitis was established. Consequently, daily dressing changes were deemed necessary for the patient's infected chest wound. Surgery for chest wall repair and reconstruction was scheduled once the wound area exhibited cleanliness with emerging granulation tissue. Preoperatively, a myocutaneous flap of an appropriate size was meticulously planned. During the surgical procedure, initial debridement of the infected chest wall area was conducted, followed by the strategic placement of a harvested pedicled latissimus dorsi myocutaneous flap to rectify the defect. Postoperative care involved stringent anti-infective measures, anti-spasmodic treatment, and preventive anticoagulation, accompanied by vigilant monitoring of the myocutaneous flap's viability and the healing progress of the defect site.

Conclusions

Utilizing the pedicled latissimus dorsi myocutaneous flap for repairing extensive defects in the chest wall presents a viable and efficient strategy. This technique preserves cardiopulmonary functionality and maintains the thoracic contour. The outcomes observed in the short to medium term postoperatively have been consistently gratifying.

Combined Porous-Monolithic TiNi Materials Surface-Modified with Electron Beam for New-Generation Rib Endoprostheses

TiNi alloys are very widely used materials in implant fabrication. When applied in rib replacement, they are required to be manufactured as combined porous-monolithic structures, ideally with a thin, porous part well-adhered to its monolithic substrate. Additionally, good biocompatibility, high corrosion resistance and mechanical durability are also highly demanded. So far, all these parameters have not been achieved in one material, which is why an active search in the field is still underway. In the present study, we prepared new porous-monolithic TiNi materials by sintering a TiNi powder (0-100 µm) on monolithic TiNi plates, followed by surface modification with a high-current pulsed electron beam. The obtained materials were evaluated by a set of surface and phase analysis methods, after which their corrosion resistance and biocompatibility (hemolysis, cytotoxicity, and cell viability) were evaluated. Finally, cell growth tests were conducted. In comparison with flat TiNi monoliths, the newly developed materials were found to have better corrosion resistance, also demonstrating good biocompatibility and potential for cell growth on their surface. Thus, the newly developed porous-on-monolith TiNi materials with different surface porosity and morphology showed promise as potential new-generation implants for use in rib endoprostheses.

Phase Composition, Microstructure, Multiple Shape Memory Effect of TiNi50-xVx (x = 1; 2; 4 at.%) System Alloys

The phase composition, microstructure, and multiple shape memory effect of TiNi_50-xV_x alloys were studied in this work. The phase composition of the TiNi_50-xV_x system is the TiNi matrix, spherical particles of TiNiV, the secondary phase Ti₂Ni(V). Doping of TiNi alloys with vanadium atoms leads to an increase in the stability of high-temperature B2 and rhombohedral R-phases. An increase in the atomic volume with an increase in the concentration of the alloying element V from 1 to 4 at.% was established. Vanadium doping of the Ti-Ni-V system alloys leads to an increase in the temperature interval for the manifestation of the multiple shape memory effect. It has been established that the value of the reversible deformation of the multiple shape memory effect both during heating and during cooling increases linearly from 2 to 4% with an increase in the vanadium concentration.

Medical Application of Functional Biomaterials-The Future Is Now

We live in unprecedented times [...].

Repair of Large-Scale Rib Defects Based on Steel-Reinforced Concrete-Designed Biomimetic 3D-Printed Scaffolds with Bone-Mineralized Microenvironments

Tissue engineering technology provides a promising approach for large-scale bone reconstruction in cases of extensive chest wall defects. However, previous studies did not consider meticulous scaffold design specific to large-scale rib regeneration in terms of three-dimensional (3D) shape, proper porous structures, enough mechanical strength, and osteogenic microenvironments. Thus, there is an urgent need to develop an appropriate bone biomimetic scaffold (BBS) to address this problem. In this study, a BBS with controllable 3D morphology, appropriate mechanical properties, good biocompatibility and biodegradability, porous structure suitable for cell loading, and a biomimetic osteogenic inorganic salt (OIS) microenvironment was successfully prepared by integrating computer-aided design, 3D-printing, cast-molding, and freeze-drying technologies. The addition of the OIS in the scaffold substantially promoted ectopic bone regeneration in vivo, which might be attributed to the activation of osteogenic and angiogenic signaling pathways as well as upregulated expression of osteogenic genes. More importantly, dual long rib defects could be successfully repaired and medullary cavity recanalized by the rib-shaped mature cortical bone, which might be mediated by the activation of osteoclast signaling pathways. Thus, this paper presents a reliable BBS and proposes a new strategy for the repair of large-scale bone defects.

Effect of Post-Deformation Annealing on Structure and Properties of Nickel-Enriched Ti-Ni Shape Memory Alloy Deformed in Various Initially Deformation-Induced Structure States

The effect of post-deformation annealing (PDA) of nickel-enriched Ti-50.9 at.% Ni shape memory alloy deformed in various initially deformation-induced structure states on the structure and properties was studied. The phase composition, temperature ranges of martensitic transformations and structure were studied using X-ray diffractometry and TEM. Mechanical and functional properties were determined using Vickers hardness tests and thermomechanical method using a bending mode for recovery strain inducing. The PDA at 430 °C (1 h) of the nickel-enriched Ti-Ni SMA with the dynamically recovered, dynamically polygonized or dynamically recrystallized structures after compressing deformation leads to the precipitation of finely dispersed (nanosized) Ti3Ni4 particles. The most significant increase of the completely recoverable strain (from 8.8 to 11.8%) and shape recovery rate (from 88 to 100%) as compared to the reference treatment is observed after PDA of the alloy with the dynamically polygonized structure.

[Reconstruction of post-resection chest wall defects in surgical treatment of invasive non-small cell lung cancer]

OBJECTIVE

To present the results of reconstruction of post-resection chest wall defects with nickel-titanium (TiNi) implants in patients with invasive NSCLC and to analyze the features of perioperative management.

MATERIAL AND METHODS

We enrolled 9 patients with NSCLC involving the ribs after lobectomy or pneumonectomy with chest wall reconstruction. Defects were closed used TiNi mesh and rib prostheses. We selected the shape and dimensions of artificial ribs individually before surgery according to CT data and 3D models of reinforcing elements.

RESULTS

There were male smokers aged 64.6±4.6 years among patients (range 58-73). T3N0M0 was diagnosed in 6 patients, T3N1M0 - 2, T3N2M0 - 1. Squamous cell carcinoma was verified in 4 (44.4%) patients, adenocarcinoma - in 5 (55.6%) patients. All patients had comorbidities. Mean Charlson's comorbidity index was 6.56±4.6. Dimension of chest wall defect varied from 78 to 100 cm². Postoperative period was uneventful without signs of respiratory failure. There were no lethal outcomes. Complications occurred in 33.3% of patients (prolonged air discharge through the drains, pleuritis and atrial fibrillation).

CONCLUSION

Surgical treatment of NSCLC spreading to the chest wall is a complex task requiring further improvement. Bioadaptive TiNi implants are a promising reinforcing material that allows successful reconstruction of post-resection chest wall defects with good anatomical, functional and cosmetic results. «Sandwich» technology is advisable for extensive defects. This approach includes 2 layers of knitted mesh and rib prostheses between these layers.