Department of Hand, Plastic and Aesthetic Surgery, LMU Klinikum, University Hospital, LMU Munich, Ziemsenstrasse 5, 80336 Munich, Germany.
Department of Breast, Plastic and Aesthetic Surgery, Frauenklinik Dr. Geisenhofer, Hirschauer Str. 6, 80538 Munich, Germany.
Int J Mol Sci. 2021 Oct 28;22(21):11667. doi: 10.3390/ijms222111667.
The use of alloplastic materials instead of autologous cartilage grafts offers a new perspective in craniofacial reconstructive surgery. Particularly for regenerative approaches, customized implants enable the surgeon to restore the cartilaginous framework of the ear without donor site morbidity. However, high development and production costs of commercially available implants impede clinical translation. For this reason, the usability of a low-cost 3D printer (Ultimaker 2+) as an inhouse-production tool for cheap surgical implants was investigated. The open software architecture of the 3D printer was modified in order to enable printing of biocompatible and biologically degradable polycaprolactone (PCL). Firstly, the printing accuracy and limitations of a PCL implant were compared to reference materials acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA). Then the self-made PCL-scaffold was seeded with adipose-tissue derived stem cells (ASCs), and biocompatibility was compared to a commercially available PCL-scaffold using a cell viability staining (FDA/PI) and a dsDNA quantification assay (PicoGreen). Secondly, porous and solid patient-customized ear constructs were manufactured from mirrored CT-imagining data using a computer-assisted design (CAD) and computer-assisted manufacturing (CAM) approach to evaluate printing accuracy and reproducibility. The results show that printing of a porous PCL scaffolds was possible, with an accuracy equivalent to the reference materials at an edge length of 10 mm and a pore size of 0.67 mm. Cell viability, adhesion, and proliferation of the ASCs were equivalent on self-made and the commercially available PCL-scaffolds. Patient-customized ear constructs could be produced well in solid form and with limited accuracy in porous form from all three thermoplastic materials. Printing dimensions and quality of the modified low-cost 3D printer are sufficient for selected tissue engineering applications, and the manufacturing of personalized ear models for surgical simulation at manufacturing costs of EUR 0.04 per cell culture scaffold and EUR 0.90 (0.56) per solid (porous) ear construct made from PCL. Therefore, in-house production of PCL-based tissue engineering scaffolds and surgical implants should be further investigated to facilitate the use of new materials and 3D printing in daily clinical routine.
使用同种异体材料替代自体软骨移植物为颅面重建外科提供了新的视角。特别是对于再生方法，定制植入物使外科医生能够在不产生供体部位发病率的情况下恢复耳朵的软骨框架。然而，商业可用植入物的高开发和生产成本阻碍了临床转化。出于这个原因，研究了低成本 3D 打印机（Ultimaker 2+）作为内部生产廉价手术植入物的工具的可用性。修改了 3D 打印机的开放软件架构，以便能够打印生物相容性和可生物降解的聚己内酯（PCL）。首先，将 PCL 植入物的打印精度和局限性与参考材料丙烯腈丁二烯苯乙烯（ABS）和聚乳酸（PLA）进行了比较。然后，将自制的 PCL 支架接种脂肪组织来源的干细胞（ASCs），并使用细胞活力染色（FDA/PI）和 dsDNA 定量测定（PicoGreen）将其与市售的 PCL 支架的生物相容性进行比较。其次，使用计算机辅助设计（CAD）和计算机辅助制造（CAM）方法从镜像 CT 成像数据制造多孔和实心患者定制的耳朵结构，以评估打印精度和可重复性。结果表明，多孔 PCL 支架的打印是可行的，其精度与参考材料相当，边长为 10mm，孔径为 0.67mm。自制和市售 PCL 支架上 ASCs 的细胞活力、粘附和增殖是等效的。实心和有限精度的多孔形式的患者定制耳朵结构都可以很好地从所有三种热塑性材料中生产。修改后的低成本 3D 打印机的打印尺寸和质量足以满足选定的组织工程应用，并且可以以每细胞培养支架 0.04 欧元的制造成本和每 PCL 实心（多孔）耳朵结构 0.90 欧元（0.56 欧元）的价格制造个性化耳朵模型用于手术模拟。因此，应进一步研究基于 PCL 的组织工程支架和手术植入物的内部生产，以促进新材料和 3D 打印在日常临床常规中的使用。
