Catharina Scheuermann Poley
Military Hospital Berlin, GermanyTitle: Funnel chest correction surgery with the aid of a 3D reconstruction of the bony thorax for preoperative adjustment of the metal bar
Abstract
Background: The funnel chest is a congenital deformity of the thorax in which the sternum and the adjacent ribs descend funnel-shaped towards the spine. The pathogenesis has not yet been clearly clarified, therefore there are different therapeutic approaches. These range from conservative measures and minimally invasive surgery to open corrective surgery. The affected patients suffer from the aesthetic impairment, as well as cardiopulmonary restrictions due to the narrowing of the mediastinal space. The indication for funnel chest correction surgery is therefore justified by functional and aesthetic reasons.
Patients: We report on a 23-year-old male patient who presented with a subjectively impairing and objectively moderate funnel chest. A chest CT scan was performed preoperatively. The sternovertebral distance was 8cm, the transverse thoracic diameter 28,9cm [Hallers index 3.6]. The preoperative pulmonary function test showed a slight restriction, the otherwise healthy patient described shortness of breath with greater exertion. The indication for funnel chest correction surgery was made. The operation was performed using a combined surgical technique: Sternotomy and cartilage wedge resection according to Brunner/Grob and implantation of the metal bar according to Nuss’ method. The most time-consuming step of the operation thus far is the intraoperative adjustment of the metal bar. Therefore, in advance of the operation, we used a 3D printer to prepare a 3D reconstruction of the bony thorax with the help of the thorax CT scan. The metal bar was then bent and fitted to the thorax print and implanted during surgery. This allowed to shorten the operation time by the step of the bar adjustment.
Results: The postoperative follow-up examinations showed a clearly erect funnel and a satisfactory aesthetic result. The metal bar explantation took place, as planned, 7 months after implantation. The postoperative CT scan now showed a Haller Index of 3.25, the pulmonary function test showed improved results. Subjectively, the patient was always symptom-free.
Conclusion: The preparation of medical implants with 3D patient models as templates helps to save operation time and resources. The practicability of our method has not yet been established, as the creation of a 3D model of the bony thorax is associated with a different kind of effort. With the increasing digitization of the medical world, however, it is conceivable that the creation of digital and real 3D models will become easier and cheaper in the future.
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