Patient Receives a 3D Printed Rib for the First Time in Bulgaria

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Ivaylo Josifov (R) with one of his surgeons

35-year-old Ivaylo Josifov was an active, healthy individual who thought he only had a case of tonsillitis when he went to the doctor recently. A chest X-ray, however, showed that he had a growth in the area of his fifth right rib. It was a congenital disease that could lead to the weakening of the chest and issues like difficulty breathing. Because of the risk that the growth could spread, the best option would be to remove the rib entirely and replace it with an implant. Josifov’s doctors decided to try something that had been done only a few times in the entire world before, and never in Bulgaria – to use 3D printing technology to create a new rib for their patient.

The doctors chose 3D printing because it could guarantee a perfect replica of the original rib shape, both in thickness and curvature. They started by scanning the original bone, then sending the scan to Bulgarian service bureau 3dbgprint. The service bureau prepared the file for 3D printing, adjusting it to be sure that it fit into the chest wall. 3dbgprint then 3D printed the implant using a 3DGence 3D printer.

“Our 3D printers ensure high 3D dimensional accuracy which was crucial in this particular medical procedure,” said Filip Turzyński, Quality Development Manager at 3DGence.  “Individually designed rib model allowed for very accurate implementation of the new element in place of the removed bone. Replacing the missing rib with a 3D printed segment with the same shape, curve, width, and thickness was possible with the use of 3DGence 3D printer.”

The new rib was 3D printed using an FDA-approved flexible, durable polyamide.

“When we had the first model ready, we started working on its sturdiness,” said Georgi Tolev of 3dbgprint. “Each consecutive model was analyzed and improved until we attained the perfect 3D print of the rib.”

Before the rib was implanted, 3 mm holes were drilled in it to facilitate broaching and proliferation of connective tissue. The implant was thoroughly sterilized, using ethylene oxide as well as gamma radiation and autoclave at 140ºC. The surgery took place at Tokuda Hospital, and the patient is back to excellent health.

Due to the success of the procedure, doctors are already planning new projects using 3D printed implants. Next, they plan to create an implant of three ribs attached to a sternum.

“This is a new era in thoracic wall reconstruction for patients with tumors that require bone-cartilage structures to be removed,” said Professor Minchev, Head of the Cardiothoracic Surgery Department at Tokuda Hospital. “The material used has proven tissue compatibility and the accuracy of reproduction allows for large chest wall resections and their single substitution with individually designed implants.”

Without 3D printing, doctors would have had a much more difficult time creating an implant that fit perfectly and matched the patient’s original rib. An ill-fitting implant could have led to pain and complications, possibly requiring additional surgery in the future. With 3D printing, however, it was possible to perfectly recreate the original rib, allowing the patient to recover quickly and go about his normal life.

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