Custom Sternum Implant
Primary malignant or metastatic sternal tumours are uncommon. A subtotal or total sternectomy can offer a radical form of treatment. The issue is to restore the structural integrity of the chest wall.
Here’s one such case of a 43yr/M patient affected with a sternal tumour. The manubrium till the xiphoid process is affected with the tumour and needs to be replaced by a customised sternum implant similar to the shape of actual anatomy with the required strength and weight, in medical-grade titanium.
Dr. Arvind Kumar, Chairman, Institute of Chest Surgery- Chest Onco Surgery & Lung Transplantation Medanta Hospital, Gurgaon, approached our clinical engineers for a robust plan and precise reconstruction of a patient-specific implant.
We mapped out to Visualize, Plan, and then execute.
To visualise the sternum anatomy and its neighbouring area, a high-resolution CT scan of adequate slice thickness and increment was used to 3D model the defect.
The region of interest was well captured in the scan and replicated as a 1:1 digital model for understanding the sternal tumour. The idea is to provide the self-explanatory model and help surgeons to make them visualize the defect which usually remains hidden in conventional 2D CT images.
Once the 3D modelling of the images (segmentation) was completed, the plan was to lay down the removal of the tumour followed by reconstruction using a customised Sternum Implant.
Key steps involved –
• Tumour to be treated with subtotal sternectomy—resection of the sternal body with the adjacent sternocostal cartilage
• Keeping similar shape of sternum and rib part, pre-designed holes at patient-specific flanges for fixation with healthy bone via suturing and screws, as applicable.
- Used single component Sternum-Ribs Implant (4 Bi-lateral ribs connected with sternum)
- Further, Porous structures were provided to reduce the weight and at the same time ensure adequate strength.
Once the surgical plan was approved and finalised, the plan was translated to physical models to analyse the outcome. Pre-op, intermediate and post-op models were printed. The customised implant was printed in medical-grade titanium.
Preplanning the surgical approach and use of the customised surgical guides and patient-specific implant, helped in achieving accurate reconstruction, reduced intra-operative time and faster recovery of the patient.