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Revista Médica del Uruguay
Print version ISSN 0303-3295On-line version ISSN 1688-0390
Abstract
BERKE, Andrés et al. First Experience in Uruguay of 3D Surgical Planning and Custom-Made Implants for Extensive Chest Wall Resections. Rev. Méd. Urug. [online]. 2025, vol.41, n.4, e703. Epub Oct 31, 2025. ISSN 0303-3295. https://doi.org/10.29193/rmu.41.4.10.
Introduction:
Oncologic resection of the chest wall creates significant defects, requiring both functional and aesthetic reconstruction. Although various reconstructive strategies exist, in this study we highlight that 3D planning and custom-made implants represent a novel technique that optimizes oncologic, functional, and aesthetic criteria, improving preoperative understanding and surgical precision.
Objective:
To document the first experience in Uruguay using this diagnostic and therapeutic strategy.
Clinical Cases:
Two cases are presented.A 64-year-old male with secondary involvement from cutaneous squamous cell carcinoma of the pectoralis minor, treated with neoadjuvant chemoradiotherapy. Surgical treatment was planned: chest wall resection with oncologic margins and parietal reconstruction. A 3D hybrid biomodel (CT, MRI, PET/CT) was created for surgical planning, and two rigid titanium implants were designed for the 1st, 2nd, and 3rd ribs. A 3D-printed PLA (polylactic acid) model of the defect was used for planning and intraoperative guidance. Coordinated surgery was performed. The patient had a favorable postoperative course, discharged on day 10, with no recurrence at 9 months follow-up. A 49-year-old female with sternal and costal metastases from breast cancer. Metastasectomy with parietal reconstruction was planned. A 3D biomodel was used for planning and prosthesis design. Coordinated surgery involved sternal and costal resection while preserving pectoral muscles, with implantation of a semi-rigid custom titanium prosthesis. The procedure was successful, and the patient was discharged on day 10, with no recurrence at 9 months follow-up.
Discussion:
En bloc surgical resection with negative margins is essential for chest wall tumor management, and reconstruction is crucial to prevent complications such as pulmonary herniation or flail chest in defects larger than 5 cm. Titanium prostheses provide a versatile option to restore rigidity and ventilatory function. This surgical planning and custom implant design strategy was used for the first time in Uruguay.
Keywords : Chest wall; Oncologic resection; Parietal reconstruction.
