How 3D printing will revolutionize reconstructive surgery
A decade ago, the idea of 3D printing body parts to seamlessly replace damaged or disfigured limbs, joints and features might have seemed like science fiction.
Today, as 3D printing technology ushers in a new era of combining biosynthetic products with our natural flesh and bone, the way surgeons treat their patients is forever changing.
In 2015, American schoolboy Dallan Jannet was the first to receive a 3D-printed nose, at the age of 14, after falling headfirst into live electrical cables.
Reconstructive surgeons restored her taste and smell with a functional 3D-printed nose that even matched her pores, skin tone, and wrinkles for a more organic feel.
Once considered revolutionary, these techniques first explored by pioneering surgeons have reached such a degree that patients can now receive custom-made prostheses perfectly suited to replace body parts.
Julian Callanan, Managing Director of Sinterex, established his 3D printing company in 2016 during the embryonic era of technology in the United Arab Emirates.
A pilot project to work alongside surgeons at the Dubai Health Authority’s Rashid Hospital ended this year and explored new areas of printing prostheses, tools and surgical guides needed for the surgical table. ‘operation.
Today, the company remains part of the emirate’s 3D Printing Strategic Alliance, a platform of the Dubai Future Foundation that brings together government entities and private companies to accelerate the use of 3D printing in various sectors.
Sinterex also now prints 3D prostheses for Mediclinic hospitals and Cleveland Clinic Abu Dhabi.
“The way to think about 3D printing in medicine is that every person is different and it allows for mass custom manufacturing,” Callanan said.
“We can do things on a large scale, which are completely individual and different.
“If you’re having knee replacement surgery, the regular artificial joint only comes in four sizes.
“So the patient is fitted to the implant, rather than the implant being fitted to the patient – like you can if it is 3D printed.”
Custom joints and jigs for surgery allow doctors to take less time to perform complex procedures and speed up patient recovery.
On average, surgeons reported 25% less time spent in the OR, thanks to advance planning enabled by the use of 3D printed models.
It provides huge savings, around $3,000 to $4,000 in costs per operation.
Printing replacement body parts such as ears, lips, or noses involves photogrammetry, a technique that takes multiple images of a patient and overlays them onto an editable model.
The files are then checked with a patient’s MRI data and CT scans to create a perfect fit.
The digital sculptures then use this data to replicate the damaged body tissue so that it can be printed and perfectly matched to the surviving tissue.
“[The] The advantages of 3D printing custom joints for patients are that they are generally more fitted, so they can be adjusted faster, last longer and are generally slightly cheaper because the surgery is shorter,” said said Mr. Callanan.
“Rather than surgeons having to manipulate a joint to fit it during surgery because it’s custom built, they know it already fits perfectly.
“In a kidney transplant case, the surgeon said that after reviewing the 3D surgical model, he changed his approach to entering the patient through the back with keyhole surgery, rather than through the stomach with a large incision.
“There was less damage to stomach tissue, so it was better for the patient.”
Dental, maxillofacial and orthopedic care are key areas of healthcare where 3D printing is now used and can replace bones and teeth using titanium or cobalt materials.
They have proven to be biocompatible over a long period of time and do not pollute the body.
Titanium is also slightly porous, which allows for oscillo-integration, where natural bone can grow into and through the titanium to be absorbed by the body.
One of those who recently benefited from a new 3D printed knee joint is Mohammad Shafiq, 69, an American in Dubai who had lived with a deformity in his right knee.
Mr Shafiq traveled regularly and endured daily pain while walking until doctors at Burjeel Hospital for Advanced Surgery in Dubai created a life-changing replacement knee joint.
An x-ray of Mr Shafiq’s knee showed unusually large bone that would make it difficult to fit a standard prosthesis, so a custom knee joint was printed instead.
A CT scan provided the exact dimensions required for the manufacturer in Switzerland, who then created a virtual model and then an implant base. It took the company three to four weeks to complete the product.
“The custom implant made it possible to perform cruciate ligament retention surgery,” said Dr. Samih Tarabichi, who performed the surgery which allowed them to retain more of the patient’s ligaments.
“We did not have to resect the posterior cruciate ligament during the surgery, thus maintaining the normal structure of the knee.
“An implant is like wearing a shirt. If it’s the wrong size, you won’t be comfortable wearing it.
3D printed knees for a perfect fit
After the full knee replacement operation, Mr. Shafiq was able to walk about an hour later.
Burjeel currently outsources its 3D printing implant operations to Symbios in Switzerland and the UK.
Currently, only around 3% of custom implants are 3D printed in hospitals, but this is expected to increase significantly.
The hospital aims to have its own 3D printing center on site within six months, to reduce reliance on foreign printers, which delays patient recovery, Dr Tarabichi said.
“It will be a breakthrough for the region,” he said.
“When we do this in-house, design and print, we can be the source of 3D printing in the GCC.
“It will save us time, from three months to just one week, and we can ship it anywhere in the Middle East.
“Building this infrastructure with IT capabilities and engineers in Dubai is doable and really exciting for us.”
Reconstructive surgery is another area of specialty care that stands to benefit greatly from new developments in 3D printing in the years to come.
From titanium implants that fit seamlessly into bone, to biomaterials used with a patient’s body tissue to reconstruct damage, 3D printing has an important role to play.
Facial features reconstructed thanks to new technologies
Dr Demetrius Evriviades, a plastic surgeon at King’s College Hospital London in Dubai, operated on Pakistani activist Malala Yousafzai to reconstruct her face after a Taliban assassination attempt on a school bus in the Swat Valley in 2012.
Dr Evriviades was one of two reconstructive surgeons who helped wounded soldiers during the worst years of the Taliban insurgency in Afghanistan, reconstructing genitals damaged by roadside bombs.
Now working in the United Arab Emirates, he is excited about the future potential of 3D printing in his field.
“This technology is extremely beneficial in our pre-surgical planning and has become routine in head and neck reconstruction surgeries,” said Dr. Evriviades.
“We can now print a perfect titanium implant that goes into the bone for amputees. It is completely anchored in the amputee’s femur, so he can then click on a prosthetic, terminator-style limb.
“It brings huge functional improvements for an amputee because they no longer have to wear a socket, which causes a lot of problems and discomfort.
“We can print a custom implant, designed specifically for this patient, based on the results of a 3D scanner. It’s like buying a ready-made suit, versus a made-to-measure suit.
In patients born without an ear or who lose one by misfortune, reconstruction is difficult.
Now, biological scaffolds can be printed to implant ear reconstructions.
It involves harvesting costal cartilage and spending hours sculpting a scaffolding for an ear, securing it with wires, implanting it in the head, and then covering it with biological tissue and skin.
“We are at the dawn of a new era of tissue engineering,” said Dr. Evriviades.
“By printing a biological scaffold, you can create a perfect replica of someone’s ear which can then be implanted and transferred. It’s an exciting development. »
Tissue manufacturing is already in place, where bovine collagen and shark fin cartilage are used to generate new human skin with a layer of silicon on top, called Integra.
It can be used to make the dermis, the inner layer of skin below the epidermis. The body grows there, it is vascularized and eventually replaces bovine collagen and shark collagen with the patient’s new dermis.
It takes a few weeks but it’s a way to create new skin, without the nerve endings and hair follicles.
“In reconstruction, if you can take something from elsewhere in the body, it’s less likely to be rejected by the body,” Dr. Evriviades said.
“But this comes at a cost to the patient, with additional surgery, scarring, pain and morbidity. If we can take a patient’s cells and grow them into more cells to populate them into a structure, that’s the holy grail.
Updated: October 07, 2022, 6:00 p.m.