Chen Hsin-Yu, Ng Li-Shia, Chang Chun-Shin, Lu Ting-Chen, Chen Ning-Hung, Chen Zung-Chung
Taoyuan and Linko, Taiwan; and Singapore.
From the Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University; Sleep Center, Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital; and the Department of Otolaryngology, Head and Neck Surgery, National University Health System, National University of Singapore.
Plast Reconstr Surg. 2017 Jun;139(6):1433-1443. doi: 10.1097/PRS.0000000000003374.
Advances in three-dimensional imaging and three-dimensional printing technology have expanded the frontier of presurgical design for microtia reconstruction from two-dimensional curved lines to three-dimensional perspectives. This study presents an algorithm for combining three-dimensional surface imaging, computer-assisted design, and three-dimensional printing to create patient-specific auricular frameworks in unilateral microtia reconstruction.
Between January of 2015 and January of 2016, six patients with unilateral microtia were enrolled. The average age of the patients was 7.6 years. A three-dimensional image of the patient's head was captured by 3dMDcranial, and virtual sculpture carried out using Geomagic Freeform software and a Touch X Haptic device for fabrication of the auricular template. Each template was tailored according to the patient's unique auricular morphology. The final construct was mirrored onto the defective side and printed out with biocompatible acrylic material.
During the surgery, the prefabricated customized template served as a three-dimensional guide for surgical simulation and sculpture of the MEDPOR framework. Average follow-up was 10.3 months. Symmetric and good aesthetic results with regard to auricular shape, projection, and orientation were obtained. One case with severe implant exposure was salvaged with free temporoparietal fascia transfer and skin grafting.
The combination of three-dimensional imaging and manufacturing technology with the malleability of MEDPOR has surpassed existing limitations resulting from the use of autologous materials and the ambiguity of two-dimensional planning. This approach allows surgeons to customize the auricular framework in a highly precise and sophisticated manner, taking a big step closer to the goal of mirror-image reconstruction for unilateral microtia patients.
CLINCIAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
三维成像和三维打印技术的进步已将小耳畸形重建术前设计的前沿从二维曲线扩展到三维视角。本研究提出了一种将三维表面成像、计算机辅助设计和三维打印相结合的算法，用于在单侧小耳畸形重建中创建患者特异性耳廓支架。
2015年1月至2016年1月，纳入6例单侧小耳畸形患者。患者平均年龄7.6岁。使用3dMDcranial获取患者头部的三维图像，并使用Geomagic Freeform软件和Touch X触觉设备进行虚拟雕刻以制作耳廓模板。每个模板均根据患者独特的耳廓形态进行定制。最终构建体镜像到患侧，并用生物相容性丙烯酸材料打印出来。
手术过程中，预制的定制模板作为MEDPOR支架手术模拟和雕刻的三维导向。平均随访10.3个月。在耳廓形状、突出度和方向方面获得了对称且良好的美学效果。1例严重植入物外露的病例通过游离颞顶筋膜转移和植皮得以挽救。
三维成像和制造技术与MEDPOR的可塑性相结合，克服了使用自体材料和二维规划的模糊性所带来的现有局限性。这种方法使外科医生能够以高度精确和精细的方式定制耳廓支架，朝着单侧小耳畸形患者镜像重建的目标又迈进了一大步。
临床问题/证据水平：治疗性，IV级。
