1. Implant Failure: STRATOS System for Pectus Repair
Prashant K. Sharma, PhD, Tineke P. Willems, PhD, Daan J. Touw, PhD, Willem Woudstra, BASc, Michiel E. Erasmus, PhD, Tjark Ebels, PhD 
The Annals of Thoracic Surgery 
Volume 103, Issue 5, Pages (May 2017)
DOI: /j.athoracsur
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(a) Different parts of the STRATOS implant; (b) the crimp connector; and (c) the connecting bar.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Single or multiple failures (red arrows) observed in vivo for (a, b) single and (c) double STRATOS implants placed for pectus correction from December 14, 2011, to July 18, 2013, at University Medical Center Groningen. (a) and (b) also show loose implant pieces freely floating in the cardiothoracic region.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
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4. Fig 3
Titanium wear debris at the failure site. (a) Preoperative failure site for patient 10 from Table 1. (b) Closeup of the failure site from which a biopsy was taken and fixated. (c) Hematoxylin-stained section of the biopsy tissue, individual frames obtained at ×10. (d) Optical micrograph taken at ×10 from the red square shown in (c). (e) Scanning electron micrograph taken from the red square shown in (c) clearly shows presence of individual and aggregated debris. (f) Overlay of titanium Kα peak intensity map on the scanning electron micrograph from the red rectangle shown in (e). (g) High titanium peaks (Kα and Lα) visible on the energy dispersive radiograph spectroscopy spectrum taken at the red square on (f). Optical micrographs taken at ×10 of (h) stained and (i) unstained sections from biopsies taken for other failed implants; black spots show wear debris.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
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5. Fig 4
Three types of failures observed: (a) clean fracture of connecting bars, designated FCB; (b) loosening and opening, sometimes accompanied by fracture of crimp connector leading to excessive rubbing between connecting bar and crimp connector, designated LCC, and (c) clean fracture observed on lateral bar at the point of reduced cross-section and stress concentration, designated FRC. From patient 1, (d) optical micrographs and (e) scanning electron micrographs taken at ×95 magnification of FCB showing grainy and smooth area of fractured surface, and (f) gross wear of crimp connector and connecting bar due to loosening LCC. From patient 8, (g) the two sides of the clean fracture in lateral bar.
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6. Fig 5
Kaplan-Meier plots showing the cumulative survival of the STRATOS implants in vivo, (a) when all patients were taken together and (b) when patients carrying single or double implants were separately analyzed. Blue lines indicate one bar, green lines indicate two bars; blue hatch marks indicate one bar censored, and green hatch marks indicate two bars censored.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
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7. Fig 6
(a) Combined loading on the implant during each breathing cycle causing the fatigue crack to grow in the connecting and lateral bars of the STRATOS implant. Exaggerated crack deformation under repeated bending (b), torsional (c), and tensile (d) loads.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions