Emerging Applications of Bedside 3D Printing in Plastic Surgery

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.

Keywords: 3D printing; bedside; cost; desktop application; education; intraoperative guidance; plastic and reconstructive surgery; preoperative planning.

Figure 1

Steps involved from imaging to 3D-printed models. Abbreviations: DICOM, digital imaging and communications in medicine; CT, computed tomography; MRI, magnetic resonance imaging.

Figure 2

3D-printed haptic model of a heart and the great vessels fabricated using Projet x60 series 3D printers. Reproduced with permission from Centre for Human Anatomy and Education.

Figure 3

Photograph of the soft tissue ankle defect showing the exposed metal hardware from a previous ankle reconstruction. Reproduced with permission from Microsurgery (109).

Figure 4

3D images of the right (pathological) ankle is juxtaposed to the left (normal) ankle (A). The left ankle is reflected (B) and superimposed on to the right ankle (C). These images are subtracted from each other to produce a “reverse” model of the soft tissue defect (D-F). Reproduced with permission from Microsurgery (109).

Figure 5

3D-printed haptic model of the soft tissue ankle defect. Reproduced with permission from Microsurgery (109).

Figure 6

3D-printed haptic model of the “reverse” image representing the wound defect. Reproduced with permission from Microsurgery (109).

Figure 7

3D reconstructed CT images of a patient with breast asymmetry post-mastectomy (A) and the 3D printed breast model of the same patient (B). Reproduced with permission from Breast Cancer Research and Treatment (108).

Figure 8

4D-printed haptic models of carpal and metacarpal bones demonstrating thumb abduction (from left to right). Reproduced with permission from Journal of Reconstructive Microsurgery (119).