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.
Highlights
Advanced medical imaging has become an essential component of preoperative planning in plastic surgery
The authors demonstrated the benefits of physically interacting with the model and the ability to visualize it in multiple planes to aid dissection and identification of the dominant perforator
A New Evolution: 4D Printing Recently, we described for the first time the concept of applying 3D printing to 4D computed tomography (CT) scans, or 4D printing, where time is added as the fourth dimension to the standard 3D printing [119]. 4D CT is a novel imaging modality developed to remove motion artifacts from organs, such as lungs, in order to enhance the image quality and facilitate precise delivery of radiotherapy [136, 137]
Summary
Advanced medical imaging has become an essential component of preoperative planning in plastic surgery. This helped the surgeon preoperatively appreciate the length, width, and depth of the free flap that needed to be harvested in order to adequately cover the defect Both the pathological ankle and the “reverse” model were fabricated in PLA filaments using a Cube 2 printer (3D Systems) (Figures 5 and 6) (Table S1 in Supplementary Material). The authors demonstrated the benefits of physically interacting with the model and the ability to visualize it in multiple planes to aid dissection and identification of the dominant perforator They noted a significant cost associated with outsourcing the 3D printing (USD 400–1,200) and the print material was too delicate for small-size blood vessels that required post-production strengthening with wax coating. The information was useful for planning the optimal method of reduction
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