METHOD FOR SURGICAL RECONSTRUCTION OF THE ANTERIOR CHEST WALL AFTER EXTENSIVE RESECTION OF THE STERNUM WITH A COMBINED IMPLANT MADE BY DUPLICATING A THREE-DIMENSIONAL STEREOLITHOGRAPHIC MODEL Russian patent published in 2022 - IPC A61B17/56 A61B17/68 A61B17/80 A61F2/28 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely thoracic surgery, and can be used for surgical reconstruction of the anterior chest wall after extensive resection of the sternum with a combined implant. Before performing surgical reconstruction, the volume of the lesion of the anterior chest wall is visualized by multispiral computed tomography, the prevalence of the tumor process is estimated and the volume of resection of the sternum and soft tissues of the chest wall is planned. Three-dimensional computer modeling of the thoracic-rib complex is performed using the Inobitec DICOM Viewer and Blender software package. Using a pre-prepared stereolithographic model of the removed part of the sternum, a mold for making an implant from bone cement is printed on an FDM printer for use during surgical intervention. The mold for the manufacture of the implant is made of biologically compatible dental silicone. After the anesthetic aid, when the patient is on his back with his arms along the body, a T-shaped incision of the skin is performed, while a transverse incision is made over the collarbones and a longitudinal incision along the midline of the body from the jugular notch to 4-6 intercostal space. The subcutaneous tissue, the breast’s own fascia are dissected by layers. The large pectoral muscles are isolated and cut off from the place of their attachment to the sternum and cartilaginous segments of ribs 2-7. The muscles are withdrawn to the level of the midclavicular lines in the lateral direction. A channel is formed in the retrosternal space behind the handle of the sternum and a channel at the level of the transverse intersection of the sternum at the level of the 3-4 intercostals. In the transverse direction, the sternum is crossed using a sternotom or a Gigli saw. The removed part of the sternum is pulled up and the sternal-rib joints are consistently crossed. Exarticulation is performed in the sternoclavicular joints. The reconstructive stage of the operation is performed, during which the actual boundaries of the performed resection of the handle and the body of the patient’s sternum are marked and applied on the preoperatively prepared form for the manufacture of the implant, the mold is sterilized for the manufacture of the implant and using the marked boundaries, the mold is filled with self-curing radiopaque cement with an antibacterial preparation and an implant is formed for the reconstruction of the anterior chest wall. Before the cement of the implant is cured, a pre-prepared titanium nickelide mesh is pressed into its body, the dimensions of which exceed the dimensions of the implant by 20-30 mm for use when fixing the implant to the cartilaginous segments of the ribs. After the implant material has cured, it is removed from the mold and through holes are made along its entire length for use in the process of fixing the implant to the sternum and ribs. Two fixing titanium plates with six fixing holes are placed on the lower part of the implant body and fixed in parallel using three screws. Also, holes are drilled in the implant body to ensure the outflow of the resulting fluid from the retrosternal space. The prepared implant is placed in a surgically formed defect of the anterior chest wall and fixed to the sternal ends of the collarbones with 8-shaped tendon sutures with a FiberTap thread. The implant is fixed to the body of the sternum with three screws through the holes of the fixing titanium plates and fixed to the cartilaginous segments of ribs 2-3 with a continuous winding suture through the protruding edges of the titanium nickelide mesh. Retrosternal and subpectoral spaces are drained. The large pectoral muscles are isolated to the level of the middle clavicular line, moved in the central direction and fixed to the previously applied sutures on the front surface of the installed implant, closing the latter. Layer-by-layer suturing is performed. At the same time, vancomycin or gentamicin is used as an antibacterial drug.

EFFECT: method provides reliable fixation of the implant to the post-resection defect of the chest, obliteration of the pleural cavity, filling the volume of the post-resection defect, reducing the excursion of the chest, exudation, eliminating the possibility of infection in places of dissection of bone structures and placement of the implant, as well as improving the quality of life of patients due to reconstruction of the anterior chest wall with a combined implant.

1 cl, 1 ex