Combination of solid and porous Nitinol implants in surgical treatment of extensive post-excision thoracic defects in cancer patients

Extensive chest wall resection and subsequent reconstruction is a challenging procedure that requires a multidisciplinary approach, including input from oncologists, thoracic and plastic surgeons. The goals of a successful chest wall repair are to restore the chest wall rigidity, preserve pulmonary mechanics, and protect the tissues from bulging, minimizing the thoracic deformity and flotation. Metallic-based materials for extensive chest wall defect repair, suggested by the current Medtech market are shaped typically using 3D printing, sophisticated machining processes, etc. However, significant issues and limitations remain in the existing solutions – cost, reproducibility of the microstructure, and biomechanical properties of the artificial rib. These remaining major challenges require the development of alternative materials and surgical procedures.

We suggested a fabrication method for rib substitutes based on porous SHS-TiNi combined with wrought Nitinol implant and knitted Nitinol light surgical meshes as an alternative for reconstruction of extensive thoracic post-excision lesions. This provides advantages over conventional rib substitutes for surgical management of huge defects and their complications; including reproducibility, affordability, and intraoperative customization.

Developing Nitinol-related biomaterials opens the opportunity to create new routes which accord well with a higher surgical level of thoracic defect repair. In the present work, we evaluate and report sixteen clinical cases based on the reconstruction of extensive thoracic defects aggravated with hernias, sepsis, osteomyelitis, etc. in cancer patients. The combined implant of knitted Nitinol surgical mesh and solid-porous Nitinol sandwich as an artificial rib is seen to exhibit superelastic behavior, remarkable mechanical/fatigue performance, and high biocompatibility level in vivo.