Patient‑specific 3D‑printed Ti‑6Al‑4 V sternum–rib implant for near‑total sternal resection: operational blueprint, implant design principles, and intermediate clinical outcome

Large sternal resections jeopardize chest-wall rigidity and cardiopulmonary protection. Conventional reconstructions often trade anatomical conformity for convenience. Three-dimensional planning and patient-specific titanium (Ti-6Al-4 V) implants may reconcile oncologic goals with stable mechanics; however, detailed end-to-end workflows are seldom reported.

We implemented a CT-to-implant workflow - segmentation, virtual resection, CAD with lateral rib-coupling flanges and soft-tissue eyelets, polymer prototype rehearsal, additive manufacturing, and single-stage implantation - for a 28-year-old man with a sternal giant cell tumor. Near-total sternectomy was followed by rigid prosthetic fixation to a manubrial sliver, xiphoid remnant, and medial rib stumps. Double-layer polypropylene mesh (deep barrier and superficial buttress) and preserved pectoral muscle coverage enabled flap-less soft-tissue reconstruction.

Estimated blood loss was 300 ml. The patient was extubated on table, the subcutaneous drain was removed on postoperative day 2, the intercostal drain on postoperative day 5, and total hospital stay was 5 days. Recovery was uncomplicated with oral-analgesic pain control and satisfactory early function. The cost of the prosthesis was INR 180,000 (approximately US$1,950). Final histopathology confirmed giant cell tumor with negative margins (R0 resection). Preoperative spirometry showed a restrictive pattern; repeat spirometry at approximately 1 month showed an overall improvement of about 20% in major parameters, although the original postoperative printout was not retrievable. At 6-month follow-up, the patient had resumed work and reported only intermittent mild pain not requiring analgesics.

We present a pragmatic operational blueprint for patient-specific sternal reconstruction that highlights anchorage strategy, rib coupling, and soft-tissue suspension. The case demonstrates feasibility in a specialized multidisciplinary setting, but longer-term oncologic, functional, and implant-durability data remain necessary.