Necessity of pleura repair in the chest wall reconstruction with three-dimensional printed titanium implant

J Thorac Dis 2020;12(5):2713-2716 | http://dx.doi.org/10.21037/jtd.2020.04.53 The main indications for chest wall reconstruction include malignancies (primary or metastatic), infections, radiationinduced necrosis, trauma and herniation (1). There are few studies on the application of bioprosthetic materials in chest wall reconstruction. Bioprosthetic materials mainly include bovine pericardial patch, porcine mesenteric patch and artificial skin patch, which are less toxic and have no effect on cell activity (2,3). However, chest wall reconstruction using bioprosthetic materials often results in insufficient tensile strength to protect intra-thoracic organs and longterm deterioration of lung elasticity. Thus, it is important to reconstruct chest wall using rigid implants for extensive chest wall defects in clinical practice (4). Three-dimensional printed (3DP) titanium implants have proved to be a novel and feasible material for individual chest wall reconstruction (5). However, titanium material has a strong hydrophobicity surface, which can prevent protein absorption and cell adhesion (6). Herein, we noticed that, the lung tissue cannot directly adhere to the 3DP titanium implants. Therefore, it is necessary to reconstruct the pleura on the inner surface of the implants. The cases are reported as follows.