PMC9450702_01
18F-fluorodeoxyglucose positron emission tomography integrated with CT showing heterogeneous radiotracer uptake within a pulmonary mass originating in the right upper lobe and infiltrating the chest wall, as well as low-grade metabolic activity in right lower paratracheal lymph nodes.
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F1
A subsequent 18F-fluorodeoxyglucose positron emission tomography integrated with CT demonstrated heterogeneous radiotracer uptake within the mass, with a maximum standardised uptake value of 20.6, as well as low-grade metabolic activity in subcarinal and right lower paratracheal lymph nodes (Figure 1).
(A) 3D digital model of the right 3rd, 4th, and 5th rib sections to be resected and reconstructed. (B) 3D printed right 3rd, 4th, and 5th rib sections in polylactic acid, used to create the silicone mould. (C) Polypropylene mesh and methyl methacrylate were placed on a silicone mould, which was created from 3D printed rib segments, to create a personalised composite implant.
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F2
The digital models were processed using the software Meshmixer (Autodesk, San Rafael, CA, USA) to keep only the rib segments that were involved by the tumour, and hence they would be resected and reconstructed during surgery (Figure 2A). The G-code was imported into the 3D printer (Ender-3, Creality, Shenzhen, China), which printed the ribs using polylactic acid filament (Polyplus, Polymaker, Shanghai, China) (Figure 2B). The meshes were tailored accordingly to leave 3 cm of prosthetic material for securing the patch to the chest wall (Figure 2C).
(A) A personalised prosthesis made of methyl methacrylate and polypropylene mesh in a "sandwich" fashion was implanted to reconstruct a chest wall defect involving the 3rd, 4th, and 5th ribs. (B) The prosthetic patch was secured to the chest wall with heavy gauge, nonabsorbable, polyfilament sutures.
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F3
The polypropylene meshes were secured on the surrounding intercostal muscles with Prolene sutures (Figure 3).
(A) Axial computed tomography of the thorax showing a personalised prosthesis contoured to the concavity of the chest wall and residing anatomically. (B) 3D reconstruction of the same computed tomography scan.
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F4
He has gradually returned to his pre-disease performance status, and he is satisfied with the functional and cosmetic result ((Figure 4).