How was “Iron Man” made?

This is the 4961st article of Da Yi Xiao Hu

As we all know, "Iron Man" is a superhero with an "iron armor" that protects the world from evil forces. As flesh and blood, we humans may occasionally desire to be a hero, but how can we be qualified and capable of becoming "Iron Man"? Let's take a look at how to become a true "Iron Man" with the help of a thoracic surgeon. . . .

Human survival mainly depends on the two major systems of circulation and respiration, of which the heart and lungs in the chest cavity are the most important bosses. The boss's umbrella is called the chest wall (mainly formed by bone structure and soft tissue). The subordinate of the chest wall: the sternum is the most capable general!

When humans are harmed by chest wall tumors, infections, trauma, radiotherapy, etc., it is inevitable that chest wall defects of varying degrees will occur, which will destroy the integrity and stability of the thorax, and human normal breathing will be affected. The sternum connects the clavicles and ribs on both sides. It is a pivotal structure of the anterior chest wall, which plays a role in supporting and stabilizing the anterior chest wall. When the sternum is surgically removed according to the condition, and the resection range is more than 5 cm. In order to protect the two bosses and restore the anatomical structure and physiological function of the thorax, a very creative thoracic surgeon is needed to help with sternum reconstruction. Build an armored suit!

The goals of sternal reconstruction are individualized according to the different conditions.

CT can clearly show the location, size, and shape of chest wall tumors without blind spots, and has become a routine examination method. The morphological characteristics of the tumor seen by CT are also helpful in determining the nature of the tumor. High-resolution CT/thin-layer CT can also provide three-dimensional reconstruction, presenting more intuitive images to surgeons. If it is suspected that the tumor involves large blood vessels or other important soft tissue structures, a magnetic resonance examination can be performed to help determine whether the tumor can be removed and the extent of resection before surgery. Doctors use the patient's CT data to obtain the normal anatomical measurements of the sternum and ribs as the basis for the design of the sternum prosthesis. The prosthesis is made of titanium alloy, and its strength is not less than 260HV10. The sternum prosthesis is divided into modules such as the sternum manubrium, sternum body, ribs and clavicle, and each module is divided into 3 to 6 models. All modules are standardized in design, and the width and thickness of each sternum module are 3mm, and the length is different. The width and thickness of each rib module are 2mm, the length and angle are different, and the left and right sides are distinguished.

The sternum modules are connected by mortise and tenon structure and fixed by screws. The rib modules and sternum modules are connected by alveolar structure, the angle is adjusted and fixed by screws.

It is not so easy to become an "Iron Man". First, endotracheal intubation and intravenous combined general anesthesia (supine position) are required. The incision varies from person to person, and the median sternotomy incision is generally the most common.

When creating "Iron Man", our hospital's surgical team independently innovated, developed and designed a modular sternal reconstruction combined prosthesis system made of titanium alloy, and obtained national patent intellectual property rights. Unlike traditional reconstruction prostheses, it avoids the disadvantage that titanium alloy plates cannot cross and overlap, is non-carcinogenic, not easy to break, not easy to get infected, and is conducive to the growth of fibrous tissue, truly helping patients become unique Iron Man. The cost is not too expensive and maintains beauty. In the past 10 years, after long-term follow-up, patients have been very satisfied with their "iron armor" worn in the chest cavity.

Because chest wall tumor resection and reconstruction surgery is basically performed under thoracotomy, compared with minimally invasive lung surgery, patients will have more obvious pain in the resection and reconstruction site in the short term after chest wall surgery, and in severe cases, it will affect breathing and expectoration. This requires pressure dressing of the wound to reduce vibration and local exudation. At the same time, abdominal breathing also helps patients breathe and expectorate effectively after chest surgery. In order to reduce postoperative exudation and infection, several drainage tubes are often left in place after chest wall reconstruction, which will cause certain inconveniences to getting out of bed and activities after surgery. Despite this, patients still need to get out of bed and move early to prevent thrombosis in the lower limbs.

Author: Shanghai Pulmonary Hospital

Operating Room Goru