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Synthesis, structure, and properties of carbon/carbon composites artificial rib for chest wall reconstruction.

ABSTRACT: In this work, braided carbon fiber reinforced carbon matrix composites (3D-C/C composites) are prepared by chemical vapor infiltration process. Their composite structure, mechanical properties, biocompatibility, and in vivo experiments are investigated and compared with those of traditional 2.5D-C/C composites and titanium alloys TC4. The results show that 3D-C/C composites are composed of reinforced braided carbon fiber bundles and pyrolytic carbon matrix and provide 51% open pores with a size larger than 100 μm for tissue adhesion and growth. The Young's modulus of 3D-C/C composites is about 5 GPa, much smaller than those of 2.5D-C/C composites and TC4, while close to the autogenous bone. 3D-C/C composites have a higher tensile strength (167 MPa) and larger elongation (5.0%) than 2.5D-C/C composites (81 MPa and 0.7%), and do not show obvious degradation after 1 × 10⁶ cyclic tensile loading. The 3D-C/C composites display good biocompatibility and have almost no artifacts on CT imaging. The in vivo experiment reveals that 3D-C/C composites artificial ribs implanted in dogs do not show displacement or fracture in 1 year, and there are no obvious proliferation and inflammation in the soft tissues around 3D-C/C composites implant. Our findings demonstrate that 3D-C/C composites are suitable for chest wall reconstruction and present great potentials in artificial bones.

SUBMITTER: Tan Z

PROVIDER: S-EPMC8163812 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Chest wall disease is a common disease in thoracic surgery. For most chest wall lesions, surgical resection is the mainstay of treatment. Reconstruction is indicated for a wide range of chest wall defects. Currently, various reconstruction materials are used in clinic, including 3D printing materials and various types of metal materials. At present, most of the studies using titanium sternum-rib fixation system for reconstruction are case reports. The purpose of this paper is to analyze the experience to discuss our essential surgical techniques for treating various types of chest wall reconstruction with a titanium sternum-rib fixation system over the last 5 years. Case Description A retrospective analysis was performed on patients with chest wall tumors treated with a titanium sternum-rib fixation system in our center from 2016 to 2020. Chest wall reconstruction techniques, experiences, postoperative complications, and quality of life including chest discomfort, chronic pain, average time to return to normal life, chest wall deformity after resection for various types of chest wall tumors were analyzed. In this study, a total of 57 patients were successfully operated without chest wall deformity and return to daily life early. With an average of 2.3 ribs removed, including 10 procedures involving sternotomy and reconstruction and 3 procedures involving sternoclavicular joint resection and reconstruction. The follow-up time of the whole group ranged from 3 months to 5 years. Postoperative chest discomfort occurred in 6 patients during follow-up; 2 patients had chronic pain. The average time to return to normal life was 1.4 months. One patient developed a deformed depression of the chest wall, and 2 patients developed wound infections. There was no perioperative death. Conclusions In our clinical experience, the titanium sternum-rib fixation system is safe, effective, and feasible. The technique is straightforward. The early and middle postoperative curative effect is satisfactory and can be used clinically.

Project description:Chest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients. Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1-3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V) It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T3-4N0-1M0. As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years.

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Synthesis, structure, and properties of carbon/carbon composites artificial rib for chest wall reconstruction.

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