Relationship between Locations of Rib Defects and Loss of Respiratory Function—A Biomechanical Study

Abstract

Objective The present study elucidates the relationship between the locations of rib defects and loss of respiratory function.

Methods Ten sets of three-dimensional finite element models were produced from computed tomography data of 10 persons and categorized as normal type models. These models were modified by removing part of the ribs, and the resultant models were categorized as defect type models. Varying the location of the defects, six types of defect model were produced from each of the 10 normal models; the defects were made on the anterior-superior, anterior-inferior, lateral-superior, lateral-inferior, posterior-superior, and posterior-inferior regions of the thorax. To simulate respiration, contracture forces were applied to nonlinear springs modeling respiratory muscles for each of the normal and defect models. Difference in volume of the thoracic cavity between inspiration and expiration phases was viewed as the indicator of respiratory function and was defined as ΔV. The values of ΔV were compared between normal type models and their corresponding defect type models.

Results Among the six types of defect, the degree of functional loss was greatest with those defects on the lateral-inferior part of the thorax, where ΔV of the affected side hemithorax drops to 38 to 45% of normal values, whereas ΔV was 62 to 88% with other defect models.

Conclusion Thoraces that have defects on their lateral-inferior regions present lower respiratory functioning than thoraces with other defect locations. Hence, in treating clinical cases where defects are expected to occur in this region, effort should be made to minimize the area of the defect.

Keywords

experimental - imaging (all modalities) - physiology - pulmonary function - robotics

• References

• 1 Berthet JP, Canaud L, D'Annoville T, Alric P, Marty-Ane CH. Titanium plates and Dualmesh: a modern combination for reconstructing very large chest wall defects. Ann Thorac Surg 2011; 91 (6) 1709-1716
• 2 D'Alessandro P, Carey-Smith R, Wood D. Large resection and reconstruction of primary parietal thoracic sarcoma: a multidisciplinary approach on 11 patients at minimum 2-years follow-up. Orthop Traumatol Surg Res 2011; 97 (1) 73-78
• 3 Di Candia M, Wells FC, Malata CM. Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses. Plast Reconstr Surg 2010; 126 (5) 1581-1588
• 4 Ferraro P, Cugno S, Liberman M, Danino MA, Harris PG. Principles of chest wall resection and reconstruction. Thorac Surg Clin 2010; 20 (4) 465-473
• 5 Blasberg JD, Donington JS. Infections and radiation injuries involving the chest wall. Thorac Surg Clin 2010; 20 (4) 487-494
• 6 Iarussi T, Pardolesi A, Camplese P, Sacco R. Composite chest wall reconstruction using titanium plates and mesh preserves chest wall function. J Thorac Cardiovasc Surg 2010; 140 (2) 476-477
• 7 Kopperdahl DL, Pearlman JL, Keaveny TM. Biomechanical consequences of an isolated overload on the human vertebral body. J Orthop Res 2000; 18 (5) 685-690
• 8 Yamada H In: Mechanical properties of loco-motor organs and tissues. Evans FG, , ed. Strength of Biological Materials. Baltimore, MD: The Williams & Wilkins Company; 1970: 93-105
• 9 Nagasao T, Miyamoto J, Hikosaka M , et al. Appropriate diameter for screws to fix the maxilla following Le Fort I osteotomy: an investigation utilizing finite element analysis. J Craniomaxillofac Surg 2007; 35 (4–5) 227-233
• 10 Nagasao T, Tamada I, Miyamoto J , et al. Effectiveness of additional transmalar Kirschner wire fixation for a zygoma fracture. Plast Reconstr Surg 2007; 119 (3) 1010-1019
• 11 Nagasao T, Miyamoto J, Nagasao M , et al. The effect of striking angle on the buckling mechanism in blowout fracture. Plast Reconstr Surg 2006; 117 (7) 2373-2380 , discussion 2381
• 12 Nagasao T, Miyamoto J, Jin H , et al. The dynamics in implantation for patients with clefts. Cleft Palate Craniofac J 2006; 43 (1) 84-91
• 13 Nagasao T, Nakajima T, Kimura A, Kaneko T, Jin H, Tamaki T. The dynamic role of buttress reconstruction after maxillectomy. Plast Reconstr Surg 2005; 115 (5) 1328-1340 , discussion 1341
• 14 Nagasao T, Noguchi M, Miyamoto J , et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg 2010; 140 (6) 1294-1299 , e1
• 15 Akaishi S, Akimoto M, Ogawa R, Hyakusoku H. The relationship between keloid growth pattern and stretching tension: visual analysis using the finite element method. Ann Plast Surg 2008; 60 (4) 445-451
• 16 Mizunuma M, Yanai A, Tsutsumi S , et al. Can dog-ear formation be decreased when an S-shaped skin resection is used instead of a spindle skin resection? A three-dimensional analysis of skin surgery techniques using the finite element method. Plast Reconstr Surg 2000; 106 (4) 845-848 , discussion 849–851