Li XA, Chen JY, Bu J, Wu HW. Customized three-dimensional printed titanium ribs combined with bilateral flaps for reconstruction of chest wall defect: A case report. World J Orthop 2026; 17(4): 117533 [DOI: 10.5312/wjo.v17.i4.117533]
Corresponding Author of This Article
Hong-Wei Wu, MD, PhD, Chief Physician, Principal Investigator, Researcher, Department of Orthopedics, Zhejiang University School of Medicine, The Fourth Affiliated Hospital, No. 1 Shangcheng Avenue, Yiwu 320002, Zhejiang Province, China. hongweiwu@zju.edu.cn
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Surgery
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Case Report
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Apr 18, 2026 (publication date) through Apr 16, 2026
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World Journal of Orthopedics
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Li XA, Chen JY, Bu J, Wu HW. Customized three-dimensional printed titanium ribs combined with bilateral flaps for reconstruction of chest wall defect: A case report. World J Orthop 2026; 17(4): 117533 [DOI: 10.5312/wjo.v17.i4.117533]
World J Orthop. Apr 18, 2026; 17(4): 117533 Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.117533
Customized three-dimensional printed titanium ribs combined with bilateral flaps for reconstruction of chest wall defect: A case report
Xian-An Li, Jia-Yi Chen, Jie Bu, Hong-Wei Wu
Xian-An Li, Jie Bu, Department of Orthopedics, Hunan Cancer Hospital, Changsha 410013, Hunan Province, China
Jia-Yi Chen, Department of Orthopedics, Zhejiang University, Yiwu 320000, Zhejiang Province, China
Hong-Wei Wu, Department of Orthopedics, Zhejiang University School of Medicine, The Fourth Affiliated Hospital, Yiwu 320002, Zhejiang Province, China
Co-first authors: Xian-An Li and Jia-Yi Chen.
Author contributions: Li XA designed and performed the operation; Chen JY and Bu J finished the writing; Wu HW conducted figure curation, writing-review & editing.
Supported by Hunan Provincial Health and Family Planning Commission, No. C20180690.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hong-Wei Wu, MD, PhD, Chief Physician, Principal Investigator, Researcher, Department of Orthopedics, Zhejiang University School of Medicine, The Fourth Affiliated Hospital, No. 1 Shangcheng Avenue, Yiwu 320002, Zhejiang Province, China. hongweiwu@zju.edu.cn
Received: December 10, 2025 Revised: January 25, 2026 Accepted: February 28, 2026 Published online: April 18, 2026 Processing time: 122 Days and 2.6 Hours
Abstract
BACKGROUND
Myxofibrosarcoma (MFS) is a rare soft-tissue tumor composed mainly of fibroblasts and fibrocytes. It commonly occurs in the limbs of older patients and is characterized by a high incidence of local recurrence and distant metastasis. On rare occasions, MFS can occur in the chest wall; however, extensive chest wall resection and reconstruction carry a high risk of complications. Moreover, resection and reconstruction are more challenging in recurrent malignant tumors.
CASE SUMMARY
Here, we report a case involving a giant neoplasm at the thoracoabdominal junction, resulting in a large composite defect (34 cm × 22 cm) after tumor resection. We successfully combined a custom-made three-dimensional (3D) titanium rib prosthesis with bilateral femoral anterolateral thigh musculocutaneous flaps to reconstruct the chest wall. During 3 years of follow-up, the patient did not report symptoms of discomfort, such as delayed prosthesis-related infection, respiratory restriction, chest pain, or distal metastatic lesions.
CONCLUSION
3D-printed titanium prostheses combined with bilateral femoral anterolateral thigh musculocutaneous flaps are feasible for reconstruction of massive chest wall defects.
Core Tip: This case report details the management of a massive thoracoabdominal wall soft tissue sarcoma using a multidisciplinary, collaborative approach combined with medicine-engineering integration. Following meticulous perioperative optimization, three-dimensional printed titanium alloy prostheses and free bilateral anterolateral thigh myocutaneous flaps were used to reconstruct the extensive bony and soft tissue defects of the chest wall, respectively, with highly satisfactory short-term postoperative outcomes. Notably, the combined thoracoabdominal wall defect at the surgical site measured 750 cm2, which, to the best of our knowledge, represents the largest reported repair of a thoracoabdominal wall defect secondary to soft tissue sarcoma to date.
