Surgeons reconstruct breast bone using 3D imaging of rib cage, first time in India

Surgeons reconstruct breast bone using 3D imaging of rib cage, first time in India

N. B. Nair

Kochi (ISJ): The parents of a nine-month old girl from Kasargod district of Kerala noticed their child's heart bulging out while beating. They were so scared even to give a bathe to the child, lest it would get hurt and finally took her to a private hospital in Kochi.

Doctors on detailed examination found the baby was born with a very rare condition called complete cleft sternum, an extremely rare condition seen usually one in one lakh live births. It is usually an incomplete cleft and very rarely complete cleft.

The sternum or the breast bone is in the midline in front of the chest wall and is extremely important as the ribs join it directly or indirectly. It along with the ribs protects the contents of the chest. It is also essential for proper breathing of the person.

Narrow or small clefts can get away without surgery. But wide clefts, complete clefts with herniation of the heart and the great vessels are very dangerous and can cause sudden death even with mild trauma to the chest wall. They also have a condition called paradoxical respiration where the chest wall moves inward on inspiration instead of going outward as in normal individuals. This causes laboured breathing and frequent respiratory illnesses.

Pediatric surgeons and cardiologists examined the case and decided to do a 3D CAT Scan and print the image of the ribs for find the extend of the deformity.

"We did a 3D CT scan and printed the ribs and the available cartilages that formed the edges of the cleft. We used the model and planned where the sternal edge should be cut to bring the edges together. Also the angle and how much of the cleft edges could be excised was also planned. We selected the best rib that had to be used to bridge the sternal defect and the length and the part of it was also decided on the model. We knew how much cartilage we would get to use to augment the rib graft," Dr Sundeep Vijayaraghavan, Clinical Professor of Plastic Surgery at Amrita Institute of Medical Sciences & Research Centre, Kochi told Indian Science Journal.

Dr Vijayaraghavan said, 3D printing is a useful tool in surgical application. It helps to understand complex deformities of the head and neck region, heart and chest wall, joints and bones. Various materials can be used for the printing. In case of a loss of a part of the cranial vault, after a 3D CT scan of the region, using software the lost part can be simulated with a mirror image. This is later printed with titanium. This perfect titanium implant is sterilized and fixed in place in a simple procedure. He said, earlier surgeons had to harvest ribs, split them and then screw them in place on the skull in a very complex and time consuming procedure. Similarly it has helped in jaw and facial bone reconstructions, joint replacements etc.

In an effort to make the actual surgery error-free, the team of surgeons had gone through the procedure several times on a model.

Dr Vijayaraghavan said, the technique is now finding new uses in several parts of medicine. Though they had been using 3D technology in complex facial bone reconstruction both in trauma and tumour surgery, it is for the first time it was used to reconstruct breast bone in India. "what we have done is not reported in journals to date to the best of our knowledge," he affirmed.

Dr Vijayaraghavan further said, the child is now perfectly normal in so far as her heart and breast bones are concerned, except that she would need two-three months of follow-up treatment. But she has another unrelated problem. Her color bones are not developed. Though functionally, the child does not have any difficulties with it, there is a small contraction, which needs to be surgically corrected after two-three years.


Image: Representative (Courtesy: Wikipedia Commons)


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