<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902025000401703</article-id>
<article-id pub-id-type="doi">10.29193/rmu.41.4.10</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Primera experiencia en Uruguay de planificación quirúrgica 3D y uso de implantes a medida en resecciones extensas de pared torácica]]></article-title>
<article-title xml:lang="en"><![CDATA[First Experience in Uruguay of 3D Surgical Planning and Custom-Made Implants for Extensive Chest Wall Resections]]></article-title>
<article-title xml:lang="pt"><![CDATA[Primeira Experiência no Uruguai de Planejamento Cirúrgico 3D e Uso de Implantes Sob Medida em Ressecções Extensas da Parede Torácica]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Berke]]></surname>
<given-names><![CDATA[Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Trostchansky Vasconcellos]]></surname>
<given-names><![CDATA[Julio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Durand]]></surname>
<given-names><![CDATA[Emilio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Palacio]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bruno]]></surname>
<given-names><![CDATA[Gerardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Maciel  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>41</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902025000401703&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902025000401703&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902025000401703&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La resección oncológica de la pared torácica crea defectos significativos, demandando una reconstrucción funcional y estética. Aunque existen diversas estrategias reconstructivas, en este trabajo destacamos la planificación 3D y los implantes a medida representan una técnica novedosa que optimiza los criterios oncológicos, funcionales y estéticos, mejorando la comprensión preoperatoria y la precisión quirúrgica.  Objetivo: Documentar la primera experiencia en Uruguay de esta estrategia de diagnóstica y terapéutica.  Casos clínicos: Se presentan dos casos clínicos. Paciente masculino de 64 años, secundarismo de carcinoma espinocelular de piel en pectoral menor, tratado con quimiorradioterapia neoadyuvante. Se plantea tratamiento quirúrgico: resección de pared torácica con márgenes oncológicos y reconstrucción parietal. Se realizó un biomodelo híbrido 3D (TC, RM, PET/TC) para planificación quirúrgica, se diseñan dos implantes rígidos de titanio para las costillas 1a, 2a y 3a. La impresión 3D del defecto en PLA (ácido poliláctico) para planificación y guía intraoperatoria. Se realiza cirugía de coordinación. El paciente tuvo una buena evolución, alta al décimo día y sin recidiva a los 9 meses de seguimiento. Paciente femenina de 49 años con metástasis esternal y costal de cáncer de mama- Se plantea metastasectomía con reconstrucción parietal. Se realizó biomodelo 3D para planificación, diseño de la prótesis parietal. Cirugía de coordinación, resección esternal y condrocostal con preservación de pectorales, implante de la prótesis de titanio semirrígida a medida. Se realizó la cirugía con éxito y la paciente fue dada de alta al décimo día, sin signos de recidiva a los 9 meses de seguimiento.  Discusión: La resección quirúrgica en bloque con márgenes negativos es primordial para el tratamiento de tumores de pared torácica, y la reconstrucción es crucial para prevenir complicaciones como la herniación pulmonar o el volet costal en defectos mayores de 5 cm. Las prótesis de titanio son una opción válida y versátil para restaurar la rigidez y la función ventilatoria. Esta estrategia de planificación quirúrgica y diseño de implante a medida es la primera vez que fue utilizada en Uruguay.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução: A ressecção oncológica da parede torácica cria defeitos significativos, demandando reconstrução funcional e estética. Embora existam diversas estratégias reconstrutivas, neste trabalho destacamos que o planejamento 3D e os implantes sob medida representam uma técnica inovadora que otimiza os critérios oncológicos, funcionais e estéticos, melhorando a compreensão pré-operatória e a precisão cirúrgica.  Objetivo: Documentar a primeira experiência no Uruguai com esta estratégia diagnóstica e terapêutica.  Casos Clínicos: São apresentados dois casos. Paciente masculino de 64 anos com comprometimento secundário por carcinoma espinocelular cutâneo no peitoral menor, tratado com quimiorradioterapia neoadjuvante. Foi planejado tratamento cirúrgico: ressecção da parede torácica com margens oncológicas e reconstrução parietal. Foi realizado biomodelo híbrido 3D (TC, RM, PET/TC) para planejamento cirúrgico e projetados dois implantes rígidos de titânio para as 1a, 2a e 3a costelas. A impressão 3D do defeito em PLA (ácido polilático) foi utilizada para planejamento e guia intraoperatória. A cirurgia coordenada foi realizada com sucesso. O paciente apresentou boa evolução, alta no 10° dia e sem recidiva aos 9 meses de acompanhamento. Paciente feminina de 49 anos com metástases esternais e costais de câncer de mama. Planejou-se metastasectomia com reconstrução parietal. Foi realizado biomodelo 3D para planejamento e desenho da prótese. A cirurgia coordenada envolveu ressecção esternal e condro-costal com preservação dos músculos peitorais, e implante de prótese semirrígida de titânio sob medida. O procedimento foi bem-sucedido e a paciente teve alta no 10° dia, sem recidiva aos 9 meses de acompanhamento.  Discussão: A ressecção cirúrgica em bloco com margens negativas é essencial no tratamento de tumores da parede torácica, e a reconstrução é crucial para prevenir complicações como hérnia pulmonar ou flail chest em defeitos maiores que 5 cm. Próteses de titânio são uma opção válida e versátil para restaurar rigidez e função ventilatória. Esta estratégia de planejamento cirúrgico e implante sob medida foi utilizada pela primeira vez no Uruguai.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Pared toracica]]></kwd>
<kwd lng="es"><![CDATA[Reseccion oncologica]]></kwd>
<kwd lng="es"><![CDATA[Reconstruccion parieta]]></kwd>
<kwd lng="en"><![CDATA[Chest wall]]></kwd>
<kwd lng="en"><![CDATA[Oncologic resection]]></kwd>
<kwd lng="en"><![CDATA[Parietal reconstruction]]></kwd>
<kwd lng="pt"><![CDATA[Parede torácica]]></kwd>
<kwd lng="pt"><![CDATA[Ressecção oncológica]]></kwd>
<kwd lng="pt"><![CDATA[Reconstrução parietal]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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