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3D printing opens new horizons in surgery and rehab medicine

Dr. Joseph Delano Fule Robles
10 Oct 2018
Patient demonstrating the use of soft robotic hand for rehabilitation training

Three-dimensional (3D) printing shows promise in elucidating answers in the management of complex birth defects, assists in the planning of complex surgical procedures and facilitates stroke rehabilitation, but is beset with various challenges.

“Having a 3D printer in the healthcare setting could be a promising approach for planning surgeries, educating patients, families or medical trainees, or creating personalized implants. The use of 3D models that mimic tissue consistency can help clinicians practice how to use a new device or perform new surgical methods. It can also help clinicians communicate more easily with patients and their families,” said Dr Deepa Prasad from Cardon Children’s Medical Center, Mesa, Arizona, US and Professor Michiko Watanabe from Rainbow Babies and Hospital, Cleveland, Ohio, US. [Birth Defects Res 2018, doi: 10.1002/bdr2.1367]

Investigators from New York University (NYU), New York, US recently designed personalized microtia surgical models using 3D printers and open source software platforms – an advancement over current surgical guide using a two-dimensional (2D) drawing of the contralateral ear. (Figure 1) [Birth Defects Res 2018, doi: 10.1002/bdr2.1345]

Figure 1. Final postoperative autogenous auricular construct. Photo from Birth Defects Res 2018, doi: 10.1002/bdr2.1345.

Figure 1. Final postoperative autogenous auricular construct. Photo from Birth Defects Res 2018, doi: 10.1002/bdr2.1345.

“Microtia is a defect where the external ear is misshapen or missing and is usually part of a complex disorder such as Treacher Collins syndrome. Almost 90 percent of cases are unilateral. Hence, a 3D-printed external ear can be fashioned using a mirror image of the normal ear,” the investigators explained.

In the management of congenital heart defects, conventional diagnostic imaging provides only 2D representations of the complex cardiovascular anatomy.  3D visualization techniques allow easier surgical planning for patients with complex congenital heart diseases.

After image acquisition, a 3D render is produced using a software for segmentation.  The 3D render is then converted to a 3D printable file for additive manufacturing and 3D printing. The models are then ready for use after post-processing.  (Figure 2) [Birth Defects Res 2018, doi: 10.1002/bdr2.1370]

Figure 2. Steps in producing a 3D print prototype. Images from Birth Defects Res 2018, doi: 10.1002/bdr2.1370.

Figure 2. Steps in producing a 3D print prototype. Images from Birth Defects Res 2018, doi: 10.1002/bdr2.1370.

In Hong Kong, experts at the Chinese University of Hong Kong (CUHK) recently developed a soft robotic hand using silicone 3D printing technology to facilitate rehabilitation after stroke. “The soft robotic hand can be tailor-made according to the size of the patient’s fingers and palms,” said investigator Professor Raymond Tong of the Department of Biomedical Engineering, CUHK. 

Other teams at CUHK have also applied 3D printing in personalized planning of left atrial appendage occlusion in a patient with challenging cardiac anatomy and open repair of descending thoracic aortic aneurysm in a patient with significant facial deformities and a difficult airway, respectively. [MIMS Doctor August 2016; Br J Anaesth 2018, doi: 10.1016/j.bja.2018.04.030]

“3D printing for the construction of medical implants will move toward patient-specific designs. For this technology to be effectively translated into the clinical setting, advancements have to be achieved with superior mechanical and biological functions that are coupled with minimum complications,” said Dr Sameera Wickramasinghe and colleagues from Case Western Reserve University, Cleveland, Ohio, US. [Birth Defects Res 2018, doi: 10.1002/bdr2.1352]

One of the greatest risks associated with the use of medical implants generated from 3D printing is the formation of hard-to-treat biofilms that lead to infections.  It is therefore important to explore the characteristics of materials being used in medical implants and eventually design anti-infective materials. [Birth Defects Res 2018, doi: 10.1002/bdr2.1352]

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Most Read Articles
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