One-of-a-kind titanium ribs give chondrosarcoma survivor his life back

Months after his chondrosarcoma treatment at another hospital, Chuck Lichtman developed a life-altering hernia. It made it hard to move, sleep comfortably or even breathe. But three MD Anderson surgeons came together to give Chuck a one-of-a-kind solution that ensured that the hernia – and its distressing side effects – wouldn’t return. 

“I got my life back,” he says. “I’m the most fortunate guy in the world. I have nothing but gratitude for my doctors at MD Anderson.”

Developing a hernia after chondrosarcoma surgery

In January 2017, Chuck was diagnosed with a chondrosarcoma, a rare type of bone cancer. It couldn’t be treated with chemotherapy or radiation therapy, so he flew from his home in Florida for surgery at a cancer hospital across the country. The surgery was deemed a success, and it saved Chuck’s life. He was pronounced cancer-free, although it required the surgeons to remove five and a half ribs and part of his sternum, from inside his chest. That procedure left him with a hole about the size of his hand inside his chest.

A few months later, Chuck developed a hernia – a common side effect for cancer patients who have undergone surgery. They occur when tissue starts to protrude forward because of a weakening in the surrounding area. About 33% of people who undergo an abdominal surgery, like Chuck did, experience a hernia. But Chuck’s hernia was larger than most – about the size of a large grapefruit. Without the support of his entire rib cage and abdominal wall, organs sunk into his chest cavity. It could be noticed through his shirt. It stopped his right lung from fully expanding and made it difficult for Chuck to breathe. It made it difficult to do martial arts and yoga, two activities he loves that make up his strenuous daily fitness routine, but he fought through it and continued to practice. Surgeons at the hospital where he was treated for cancer repaired the hernia, but it returned quickly. His doctors suggested performing the same surgery to repair it a second time.

“That wasn’t good enough for me,” Chuck says. “It didn’t work the first time. I didn’t want to do the same thing again.”

Chuck began researching and came across MD Anderson, where Charles Butler, M.D., chair of Plastic Surgery, had earned a reputation as a leading expert in abdominal wall reconstruction. MD Anderson plastic surgeons perform roughly 800 abdominal wall reconstruction and hernia repair procedures each year. While hernia repair procedures are performed by general surgeons at many hospitals, at MD Anderson, the procedure is done by specialized plastic surgeons.

In his research, Chuck found that Butler had written about abdominal wall repair and the use of titanium ribs, a type of medical device that MD Anderson plastic surgeons were teaming up with their colleagues in Thoracic Surgery to reconstruct chests. Chuck hoped this might solve his problem and scheduled an appointment at MD Anderson.

Coming to MD Anderson for hernia repair and chest reconstruction

In February 2019, Chuck had his first appointment at MD Anderson with Alexander Mericli, M.D., a plastic surgeon.

“Dr. Mericli quickly began to discuss my entire cancer treatment history in great detail, without any notes,” Chuck says.

“Have you heard of titanium ribs?” Mericli asked Chuck.

He had been impressed from the moment Mericli began speaking, but now, Chuck knew he was in the right place. Right away Mericli notified Butler of the potential case. Together, they took pictures and marked his chest with a marker as they discussed how they would repair the hernia and fill the chest cavity.

“I looked like geometry homework,” Chuck says with a laugh.

As a leading expert on abdominal wall reconstruction, Butler would serve as the lead plastic surgeon on the case, and Mericli would assist him. They knew that to properly perform the surgery, they would need the help of a thoracic surgeon. They called their colleague David Rice, M.D., and had Chuck meet with him as well.

This sort of close collaboration between plastic and thoracic surgeons is a common practice at MD Anderson.

“Multidisciplinary care is one of the hallmarks of what we do at MD Anderson,” Mericli says.

While titanium ribs sounded novel to Chuck, Rice explained that the top thoracic surgeons had been using them for about 15 years. Rice, who’s a part of a team of MD Anderson surgeons that perform anywhere from 40 to 100 chest reconstruction surgeries each year, knew the standard titanium rib wouldn’t work for Chuck. They connect to the patient’s sternum, and Chuck was missing most of his as a result of his cancer surgery. This was a one-of-a-kind problem and would take a one-of-a-kind solution.

Creating one-of-a-kind titanium ribs

Rice, Butler and Mericli worked with biomedical engineers to design a new set of ribs for Chuck. They met regularly for three months to review and edit the design using 3D animated reconstructions of Chuck’s CT scans. Finally, they came up with a design: three connected bands stretching from the remaining part of his middle right ribs that crossed the center of his chest and fastened to his left ribs. The swoop of the manufactured ribs matched the natural curve of his chest and the metal was dotted with small holes that could be surgically fastened to mesh that would reconstruct his chest. The design was ready to be manufactured and sent to a facility in Belgium, where a specialized 3D printer would print the design using titanium dust.

Because this design had never been used before, it had to undergo several safety reviews by MD Anderson and the Food and Drug Administration (FDA).

“I wish it was a shorter process for our patients, but we have to undergo these steps to ensure that everything was safe,” Rice says. 

Fortunately, the MD Anderson Innovation Center, an institution-wide hub that makes medical ideas become reality, and the Surgery IDEAS Lab, an in-house incubator for innovation in surgery, had the resources to walk the surgeons through the approval process.  

In August 2019, while waiting for the surgery, Chuck began to experience extreme nausea, pain and vomiting. The hernia was causing a bowel obstruction. Chuck’s care team urged him to get to MD Anderson as quickly as possible. He flew to Houston on the next available flight and was rushed to the cancer center, where surgeon David Santos, M.D., removed the obstruction. He later told Chuck he could have died if he hadn’t sought medical attention.

Life after hernia repair surgery

On Nov. 11, 2019, Chuck underwent surgery. Together, Butler, Mericli, Rice and their surgical teams repaired the hernia, rebuilt Chuck’s abdominal wall and reconstructed his chest.

For Chuck, the procedure was life-changing, but for his care team, it was just another day in the OR.

“It wasn’t much different from our other multiteam cases,” Rice says. 

Chuck’s initial recovery was painful, but little by little, he began to regain his strength. He spent eight days in the hospital followed by an additional week in Houston at a nearby hotel recovering before returning home. It wasn’t long before he was back to his fitness routine. He can’t do everything he used to do before cancer. Running is uncomfortable, for example. But he’s able enjoy new activities, like speed walking and using the elliptical.

This past March, he underwent another surgery to repair the titanium ribs, but Chuck considers it a minor inconvenience compared to all he’s endured.

“I will be eternally grateful to Drs. Butler, Rice and Mericli for changing my life, and arguably, saving it,” Chuck says. “The level of care was unparalleled by any hospital anywhere.”

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