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Background:  Pectus excavatum (PE), one of the most common congenital chest wall deformities, is characterized by posterior depression of the sternum and lower costal cartilages. In this study, we demonstrated the application of flexible three-dimensional printing thoracic models for surgical approach planning of extrapleural Nuss procedure for patients with pectus excavatum. Methods:  Six patients with pectus excavatum were referred to our hospital for extrapleural Nuss procedure. Each patient’s chest was reconstructed based on their computed tomography imaging data, and the three- dimensional (3D) thoracic model was manufactured with flexible material using 3D printing technique. The individual surgical approach and custom-made steel bars were designed and produced using these models.  Results:  The surgical approach was evaluated by using the three-dimensional thoracic model. In all patients received extrapleural Nuss surgery, it has been proven the uniformity of repair efficacy in both models and patients. Moreover, an individualized and well-fitting steel bar can be fabricated once the surgical approach was confirmed. All the steel bars were loaded against the ribs rigorously and seamlessly. Conclusions:  The flexible three-dimensional thoracic models were very helpful for the preoperative planning of extrapleural Nuss procedure.

Three-dimensional printing flexible models: a novel technique for Nuss procedure planning of pectus excavatum repair