Additive Manufacturing and Reverse Engineering in Cranioplasty: A Personalized Approach to Minimize Skin Flap Complications

Antonio Marzola,Lapo Governi,Francesco Buonamici,Rocco Furferi,Federico Mussa,Lorenzo Genitori

doi:10.3390/app11114926

Antonio Marzola, Lapo Governi + Show 4 more

Open Access

https://doi.org/10.3390/app11114926

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Abstract

Cranioplasty is a procedure performed to repair defects in the human skull bone by surgically reconstructing the shape and function of the cranium. Several complications, both intraoperative and postoperative, can affect the procedure’s outcome (e.g., inaccuracies of the reconstructed shape, infections, ulcer, necrosis). Although the design of additive manufactured implants in a preoperative stage has improved the general quality of cranioplasties, potential complications remain significant, especially in the presence of critical skin tissue conditions. In this paper, an innovative procedure to improve the chances of a positive outcome when facing critical conditions in a cranioplasty is described. The proposed approach relies on a structured planning phase articulated in a series of digital analyses and physical simulations performed on personalized medical devices that guide the surgeon in defining surgical cuts and designing the implant. The ultimate goal is to improve the chances of a positive outcome and a fast recovery for the patient. The procedure, described in extenso in the paper, was positively tested on a cranioplasty case study, which presented high risk factors.

Highlights

Cranioplasty is a surgical procedure that is performed to repair a defect in the human skull
An early surgery can avoid complications caused by changes in cerebral blood flow and cerebrospinal fluid dynamics [4], it cannot be performed before the full recovery of the wound of the primary procedure
Patients may undergo cranioplasty long after the defect appears, increasing the risks associated with the presence of the lacuna

Summary

Introduction

Cranioplasty is a surgical procedure that is performed to repair a defect in the human skull. The incidence of complications is accentuated when dealing with large defects due to the dimensions of the surgical incisions and to the higher difference in skin tension caused by introducing an implant These problems must be considered when designing cranioplasty implants. It is not exempt from complications that include infection, exposure, rupture of the expander and hematoma [8] It requires a two-stage cranioplasty, increasing the risks for the patient and the cost of the procedure. To show a different approach that can achieve an adequate esthetic result through a one-step cranioplasty and avoiding expanders, the following authors propose a strategy for an accurate assessment of scalp tissue by exploiting techniques based on reverse engineering (RE) and additive manufacturing (AM) technologies. A case study is reported to show how such procedure has allowed a one-step minimally invasive cranioplasty for a patient with a large cranial defect with an ovearolynien-gstfeibprmotiinc iimneaxltleynisnivblaesitvisesucreatnhiaotphlaadstycafuosreadpthartieeenftawiluitrhesainlaprgreevciroaunsiaclradneifoepctlaws-ith tiesanbeocvaeursleyionfgwfioburnodticdeinheisxcteenncseib. lIenttihsseuceastehasttuhdayd, tchaeusmeedththordeoelofagiyludreelsivinerpedreaviporuescicsreanevaiolupalatisotniesofbtehceaucsreitiocfawl socualnpdrdegehioisnc.eTnhcies. iInnfothrme caatisoensteundayb,ltehdetmheetphloandnoliongyodf ealimveinrei-d a mapllryeciinsveaesvivaeluianttieornveonfttihoen carnitdictahlescdaelspigrnegoifonre.laTtheids minefodrimcaal tdioenviecnesabthleadt wtheerepltaanilnoirnegd of botahmonintihmeaallnyationmvaysiovfethinetperavtieennttioandanodn the sduersgigicnalosftrraetleagteyd. medical devices that were tailored both on the anatomy of the patient and on the surgical strategy

Materials and Methods

In-Silico Skin Assessment

Physical Simulation

Findings

Discussion and Conclusions