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Wang Q, Chiu C, Zhang H, Wang X, Chen Y, Li X, Pan J. The H 2O 2 Self-Sufficient 3D Printed β-TCP Scaffolds with Synergistic Anti-Tumor Effect and Reinforced Osseointegration. Adv Healthc Mater 2024:e2303390. [PMID: 38490171 DOI: 10.1002/adhm.202303390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/13/2024] [Indexed: 03/17/2024]
Abstract
Tumor recurrence and massive bone defects are two critical challenges for postoperative treatment of oral and maxillofacial tumor, posing serious threats to the health of patients. Herein, in order to eliminate residual tumor cells and promote osteogenesis simultaneously, the hydrogen peroxide (H2O2) self-sufficient TCP-PDA-CaO2-CeO2 (TPCC) scaffolds are designed by preparing CaO2 or/and CeO2 nanoparticles (NPs)/chitosan solution and modifying the NPs into polydopamine (PDA)-modified 3D printed TCP scaffolds by rotary coating method. CaO2 NPs loaded on the scaffolds can release Ca2+ and sufficient H2O2 in the acidic tumor microenvironment (TME). The generated H2O2 can further produce hydroxyl radicals (·OH) under catalysis effect by peroxidase (POD) activity of CeO2 NPs, in which the photothermal effect of the PDA coating enhances its POD catalytic effect. Overall, NPs loaded on the scaffold chemically achieve a cascade reaction of H2O2 self-sufficiency and ·OH production, while functionally achieving synergistic effects on anti-tumor and bone promotion. In vitro and in vivo studies show that the scaffolds exhibit effective osteo-inductivity, induced osteoblast differentiation and promote osseointegration. Therefore, the multifunctional composite scaffolds not only validate the concept of chemo-dynamic therapy (CDT) cascade therapy, but also provide a promising clinical strategy for postoperative treatment of oral and maxillofacial tumor.
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Affiliation(s)
- Qing Wang
- Department of Stomatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Chingyen Chiu
- Department of Stomatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Hang Zhang
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xuan Wang
- Department of Stomatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yanzheng Chen
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xiang Li
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jinsong Pan
- Department of Stomatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
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Chen MY, Fang JJ, Lee JN, Periasamy S, Yen KC, Wang HC, Hsieh DJ. Supercritical Carbon Dioxide Decellularized Xenograft-3D CAD/CAM Carved Bone Matrix Personalized for Human Bone Defect Repair. Genes (Basel) 2022; 13:755. [PMID: 35627140 PMCID: PMC9141546 DOI: 10.3390/genes13050755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/04/2022] Open
Abstract
About 30-50% of oral cancer patients require mandibulectomy and autologous fibula reconstruction. Autograft is the gold standard choice because of its histocompatibility; however, it requires additional surgery from the patient and with possible complications such as loss of fibula leading to calf weakening in the future. Allograft and xenograft are alternatives but are susceptible to immune response. Currently, no personalized bone xenografts are available in the market for large fascial bone defects. In addition, a large-sized complex shape bone graft cannot be produced directly from the raw material. We propose the use of porcine bones with 3D CAD/CAM carving to reconstruct a personalized, wide range and complex-shaped bone. We anticipate that patients can restore their native facial appearance after reconstruction surgery. Supercritical CO2 (SCCO2) technology was employed to remove the cells, fat and non-collagenous materials while maintaining a native collagen scaffold as a biomedical device for bone defects. We successfully developed 3D CAD/CAM carved bone matrices, followed by SCCO2 decellularization of those large-sized bones. A lock-and-key puzzle design was employed to fulfil a wide range of large and complex-shaped maxillofacial defects. To conclude, the 3D CAD/CAM carved bone matrices with lock and key puzzle Lego design were completely decellularized by SCCO2 extraction technology with intact natural collagen scaffold. In addition, the processed bone matrices were tested to show excellent cytocompatibility and mechanical stiffness. Thus, we can overcome the limitation of large size and complex shapes of xenograft availability. In addition, the 3D CAD/CAM carving process can provide personalized tailor-designed decellularized bone grafts for the native appearance for maxillofacial reconstruction surgery for oral cancer patients and trauma patients.
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Affiliation(s)
- Meng-Yen Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Jing-Jing Fang
- Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Jeng-Nan Lee
- Department of Mechanical Engineering, Cheng Shiu University, Kaohsiung 833301, Taiwan;
| | - Srinivasan Periasamy
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Ko-Chung Yen
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Hung-Chou Wang
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
| | - Dar-Jen Hsieh
- R & D Center, ACRO Biomedical Co., Ltd. 2nd. Floor, No.57, Luke 2nd. Rd., Luzhu District, Kaohsiung 821011, Taiwan; (S.P.); (K.-C.Y.); (H.-C.W.)
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Zachariah T, Neelakandan RS, Murugan A. Zygomaticomaxillary "lateral swing" osteotomy for augmentation of midface deficiency. Natl J Maxillofac Surg 2019; 10:146-152. [PMID: 31798248 PMCID: PMC6883881 DOI: 10.4103/njms.njms_53_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/24/2018] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction: Various surgical modalities have been proposed for the augmentation of midface deficiency without correction of the occlusal component. They include autogenous bone and cartilage grafts, alloplastic materials, and osteotomies. We propose an innovative osteotomy technique for augmentation of the midface including the infraorbital rims, the zygoma, the anterior maxillae, and the paranasal areas without advancing the dental-bearing segment. Materials and Methods: This procedure was carried out on a 21-year-old male patient who had a deficiency of the anterior maxillae including the infraorbital rims. His occlusion was in Class I molar relation. The surgical exposure was carried out through a midface degloving approach. This bilateral osteotomy encompasses the anterior maxillae and the zygoma; the osteotomy line running superiorly from the medial aspect of the infra-orbital rim to the root of the frontal process of maxilla. Inferiorly, the line runs above the apices of the maxillary teeth laterally underneath the zygomatic buttress, separating part of the zygomaticomaxillary suture posteriorly. Medially, the osteotomy line runs parallel to the piriform aperture. The osteotomy is pedicled on the zygomaticotemporal suture. A greenstick fracture at the zygomatic arch pedicled the osteotomized segment to the zygomatic process of the temporal bone. The entire segment was swung laterally outward, effectively separating part of the zygomaticomaxillary suture posteriorly. Fixation was achieved with a single 2-mm L-shaped, 4-hole plate with gap at the zygomatic buttress region. Results: This osteotomy technique resulted in fullness of the anterior maxillae and infraorbital rims, with increased anterior and lateral projection of the zygoma. Conclusion: The zygomaticomaxillary “lateral swing” osteotomy is a reliable and stable technique for total midface augmentation not requiring occlusion correction.
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Affiliation(s)
- Thomas Zachariah
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - R S Neelakandan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Aparna Murugan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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Shen Z, Yao Y, Xie Y, Guo C, Shang X, Dong X, Li Y, Pan Z, Chen S, Xiong G, Wang FY, Pan H. The process of 3D printed skull models for anatomy education. Comput Assist Surg (Abingdon) 2019; 24:121-130. [PMID: 31012745 DOI: 10.1080/24699322.2018.1560101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In general, the 3 D printed medical models are made based on virtual digital models obtained from machines such as the computed tomography scanner. However, due to the limited accuracy of CT scanning technology, which is usually 1 millimeter, there are differences between scanned results and the real structure. Besides, the collected data can hardly be printed directly because of some errors in the model. In this paper, we present a general and efficient procedure to process the digital skull data to make the printed structures meet the requirements of anatomy education, which combines the use of five 3 D manipulation tools and the procedure can be finished within 6 hours. Then the model is printed and compared with the cadaveric skull from frontal, left, right and anterior views respectively. The printed model can describe the correct structure and details of the skull clearly, which can be considered as a good alternative to the cadaveric skull. The manipulation procedure presented in this study is an easily available and cost-effective way to obtain a printed skull model from the original CT data, which has a considerable economic and social benefit for the medical education. The steps of the data processing can be performed easily. The cost for the 3 D printed model is also low. Outcomes of this study can be applied widely in processing skull data.
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Affiliation(s)
- Zhen Shen
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China.,Qingdao Academy of Intelligent Industries , Qingdao , China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital (PUMCH) Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) , Beijing , China
| | - Yi Xie
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China.,School of Electrical & Electronic Engineering, University of Manchester , Manchester , UK
| | - Chao Guo
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China.,University of Chinese Academy of Sciences , Beijing , China
| | - Xiuqin Shang
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China.,Beijing Engineering Research Center of Intelligent Systems and Technology, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China
| | - Xisong Dong
- Qingdao Academy of Intelligent Industries , Qingdao , China.,Beijing Engineering Research Center of Intelligent Systems and Technology, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China
| | - Yuqing Li
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China.,College of Information Science and Technology, Beijing University of Chemical Technology , Beijing , China
| | - Zhouxian Pan
- PUMCH CAMS & PUMC, Eight-year Program of Clinical Medicine , Beijing , China
| | - Shi Chen
- Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, PUMCH, CAMS & PUMC , Beijing , China.,National Virtual Simulation Laboratory Education Center of Medical Sciences, PUMCH, CAMS & PUMC , Beijing , China
| | - Gang Xiong
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China.,Cloud Computing Center, Chinese Academy of Sciences , Dongguan , China
| | - Fei-Yue Wang
- The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation Chinese Academy of Sciences (CASIA) , Beijing , China
| | - Hui Pan
- Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, PUMCH, CAMS & PUMC , Beijing , China.,National Virtual Simulation Laboratory Education Center of Medical Sciences, PUMCH, CAMS & PUMC , Beijing , China.,Department of Education, PUMCH, CAMS & PUMC , Beijing , China
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Wen Y, Xun S, Haoye M, Baichuan S, Peng C, Xuejian L, Kaihong Z, Xuan Y, Jiang P, Shibi L. 3D printed porous ceramic scaffolds for bone tissue engineering: a review. Biomater Sci 2018; 5:1690-1698. [PMID: 28686244 DOI: 10.1039/c7bm00315c] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study summarizes the recent research status and development of three-dimensional (3D)-printed porous ceramic scaffolds in bone tissue engineering. Recent literature on 3D-printed porous ceramic scaffolds was reviewed. Compared with traditional processing and manufacturing technologies, 3D-printed porous ceramic scaffolds have obvious advantages, such as enhancement of the controllability of the structure or improvement of the production efficiency. More sophisticated scaffolds were fabricated by 3D printing technology. 3D printed bioceramics have broad application prospects in bone tissue engineering. Through understanding the advantages and limitations of different 3D-printing approaches, new classes of bone graft substitutes can be developed.
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Affiliation(s)
- Yu Wen
- Orthopedics Research Institute of Chinese PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, General Hospital of Chinese PLA, Fuxing Road 28, Haidian District, Beijing 100853, P. R. China.
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Application of Computer-Aided Design and Customized Implants in the Reconstruction of Pyriform Aperture Defects Secondary to Unilateral Cleft Lip and Palate. J Craniofac Surg 2017; 28:1517-1520. [DOI: 10.1097/scs.0000000000003544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bilateral Malar Reconstruction Using Patient-Specific Polyether Ether Ketone Implants in Treacher–Collins Syndrome Patients With Absent Zygomas. J Craniofac Surg 2017; 28:515-517. [DOI: 10.1097/scs.0000000000003351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Computer-Aided Design and Computer-Aided Manufacturing Hydroxyapatite/Epoxide Acrylate Maleic Compound Construction for Craniomaxillofacial Bone Defects. J Craniofac Surg 2016; 26:1477-81. [PMID: 26106993 DOI: 10.1097/scs.0000000000001410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the use of computer-aided design and computer-aided manufacturing hydroxyapatite (HA)/epoxide acrylate maleic (EAM) compound construction artificial implants for craniomaxillofacial bone defects. Computed tomography, computer-aided design/computer-aided manufacturing and three-dimensional reconstruction, as well as rapid prototyping were performed in 12 patients between 2008 and 2013. The customized HA/EAM compound artificial implants were manufactured through selective laser sintering using a rapid prototyping machine into the exact geometric shapes of the defect. The HA/EAM compound artificial implants were then implanted during surgical reconstruction. Color-coded superimpositions demonstrated the discrepancy between the virtual plan and achieved results using Geomagic Studio. As a result, the HA/EAM compound artificial bone implants were perfectly matched with the facial areas that needed reconstruction. The postoperative aesthetic and functional results were satisfactory. The color-coded superimpositions demonstrated good consistency between the virtual plan and achieved results. The three-dimensional maximum deviation is 2.12 ± 0.65 mm and the three-dimensional mean deviation is 0.27 ± 0.07 mm. No facial nerve weakness or pain was observed at the follow-up examinations. Only 1 implant had to be removed 2 months after the surgery owing to severe local infection. No other complication was noted during the follow-up period. In conclusion, computer-aided, individually fabricated HA/EAM compound construction artificial implant was a good craniomaxillofacial surgical technique that yielded improved aesthetic results and functional recovery after reconstruction.
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Ciporen J, Lucke-Wold BP, Mendez G, Chen A, Banerjee A, Akins PT, Balough BJ. Single-staged resections and 3D reconstructions of the nasion, glabella, medial orbital wall, and frontal sinus and bone: Long-term outcome and review of the literature. Surg Neurol Int 2016; 7:S1107-S1112. [PMID: 28194296 PMCID: PMC5299155 DOI: 10.4103/2152-7806.196773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/10/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aesthetic facial appearance following neurosurgical ablation of frontal fossa tumors is a primary concern for patients and neurosurgeons alike. Craniofacial reconstruction procedures have drastically evolved since the development of three-dimensional computed tomography imaging and computer-assisted programming. Traditionally, two-stage approaches for resection and reconstruction were used; however, these two-stage approaches have many complications including cerebrospinal fluid leaks, necrosis, and pneumocephalus. CASE DESCRIPTION We present two successful cases of single-stage osteoma resection and craniofacial reconstruction in a 26-year-old female and 65-year-old male. The biopolymer implants were preselected and contoured based on imaging prior to surgery. The ideal selection of appropriate flaps for reconstruction was imperative. The flaps were well vascularized and included a pedicle for easy translocation. Using a titanium mesh biopolymer implant for reconstruction in conjunction with a forehead flap proved advantageous, and the benefits of single-stage approaches were apparent. The patients recovered quickly after the surgery with complete resection of the osteoma and good aesthetic appearance. The flap adhered to the biopolymer implant, and the cosmetic appearance years after surgery remained decent. The gap between the bone and implant was less than 2 mm. The patients are highly satisfied with the symmetrical appearance of the reconstruction. CONCLUSIONS Advances in technology are allowing neurosurgeons unprecedented opportunities to design complex yet feasible single-stage craniofacial reconstructions that improve a patient's quality of life by enhancing facial contours, aesthetics, and symmetry.
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Affiliation(s)
- Jeremy Ciporen
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
- Corresponding author
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Gustavo Mendez
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Anton Chen
- Department of ENT, Kaiser Permanente, Sacramento, California, USA
| | - Amit Banerjee
- Department of Neurosurgery, Kaiser Permanente, Sacramento, California, USA
| | - Paul T. Akins
- Department of Neurosurgery, Kaiser Permanente, Sacramento, California, USA
| | - Ben J. Balough
- Department of ENT, Kaiser Permanente, Sacramento, California, USA
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Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging Applications of Bedside 3D Printing in Plastic Surgery. Front Surg 2015; 2:25. [PMID: 26137465 PMCID: PMC4468745 DOI: 10.3389/fsurg.2015.00025] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/02/2015] [Indexed: 12/16/2022] Open
Abstract
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
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Affiliation(s)
- Michael P Chae
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Warren M Rozen
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Paul G McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Clayton, VIC , Australia
| | - Michael W Findlay
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Department of Surgery, Stanford University , Stanford, CA , USA
| | - Robert T Spychal
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia
| | - David J Hunter-Smith
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
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Chae MP, Lin F, Spychal RT, Hunter-Smith DJ, Rozen WM. 3D-printed haptic "reverse" models for preoperative planning in soft tissue reconstruction: a case report. Microsurgery 2014; 35:148-53. [PMID: 25046728 DOI: 10.1002/micr.22293] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 11/06/2022]
Abstract
In reconstructive surgery, preoperative planning is essential for optimal functional and aesthetic outcome. Creating a three-dimensional (3D) model from two-dimensional (2D) imaging data by rapid prototyping has been used in industrial design for decades but has only recently been introduced for medical application. 3D printing is one such technique that is fast, convenient, and relatively affordable. In this report, we present a case in which a reproducible method for producing a 3D-printed "reverse model" representing a skin wound defect was used for flap design and harvesting. This comprised a 82-year-old man with an exposed ankle prosthesis after serial soft tissue debridements for wound infection. Soft tissue coverage and dead-space filling were planned with a composite radial forearm free flap (RFFF). Computed tomographic angiography (CTA) of the donor site (left forearm), recipient site (right ankle), and the left ankle was performed. 2D data from the CTA was 3D-reconstructed using computer software, with a 3D image of the left ankle used as a "control." A 3D model was created by superimposing the left and right ankle images, to create a "reverse image" of the defect, and printed using a 3D printer. The RFFF was thus planned and executed effectively, without complication. To our knowledge, this is the first report of a mechanism of calculating a soft tissue wound defect and producing a 3D model that may be useful for surgical planning. 3D printing and particularly "reverse" modeling may be versatile options in reconstructive planning, and have the potential for broad application.
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Affiliation(s)
- Michael P Chae
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia; Department of Surgery, Monash University, Monash Medical Centre, Clayton, VIC, Australia; Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, VIC, Australia
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