One-Year Results of Ear Reconstruction with 3D Printed Implants
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: External ear reconstruction has been a challenging subject for plastic surgeons for decades. Popular methods using autologous costal cartilage or polyethylene still have their drawbacks. With the advance of three-dimensional (3D) printing technique, bioscaffold engineering using synthetic polymer draws attention as an alternative. This is a clinical trial of ear reconstruction using 3D printed scaffold, presented with clinical results after 1 year. Materials and Methods: From 2021 to 2022, five adult patients with unilateral microtia underwent two-staged total ear reconstruction using 3D printed implants. For each patient, a patient-specific 3D printed scaffold was designed and produced with polycaprolactone (PCL) based on computed tomography images, using fused deposition modeling. Computed tomography scan was obtained preoperatively, within 2 weeks following the surgery and after 1 year, to compare the volume of the normal side and the reconstructed ear. At 1-year visit, clinical photo was taken for scoring by two surgeons and patients themselves. Results: All five patients had completely healed reconstructed ear at 1-year follow-up. On average, the volume of reconstructed ear was 161.54% of that of the normal side ear. In a range of 0 to 10, objective assessors gave scores 3 to 6, whereas patients gave scores 8 to 10. Conclusion: External ear reconstruction using 3D printed PCL implant showed durable, safe results reflected by excellent volume restoration and patient satisfaction at 1 year postoperatively. Further clinical follow-up with more cases and refinement of scaffold with advancing bioprinting technique is anticipated. The study’s plan and results have been registered with the Clinical Research Information Service (CRIS No. 3-2019-0306) and the Ministry of Food and Drug Safety (MFDS No.1182).
Abstract
Purpose: External ear reconstruction has been a challenging subject for plastic surgeons for decades. Popular methods using autologous costal cartilage or polyethylene still have their drawbacks. With the advance of three-dimensional (3D) printing technique, bioscaffold engineering using synthetic polymer draws attention as an alternative. This is a clinical trial of ear reconstruction using 3D printed scaffold, presented with clinical results after 1 year. Materials and Methods: From 2021 to 2022, five adult patients with unilateral microtia underwent two-staged total ear reconstruction using 3D printed implants. For each patient, a patient-specific 3D printed scaffold was designed and produced with polycaprolactone (PCL) based on computed tomography images, using fused deposition modeling. Computed tomography scan was obtained preoperatively, within 2 weeks following the surgery and after 1 year, to compare the volume of the normal side and the reconstructed ear. At 1-year visit, clinical photo was taken for scoring by two surgeons and patients themselves. Results: All five patients had completely healed reconstructed ear at 1-year follow-up. On average, the volume of reconstructed ear was 161.54% of that of the normal side ear. In a range of 0 to 10, objective assessors gave scores 3 to 6, whereas patients gave scores 8 to 10. Conclusion: External ear reconstruction using 3D printed PCL implant showed durable, safe results reflected by excellent volume restoration and patient satisfaction at 1 year postoperatively. Further clinical follow-up with more cases and refinement of scaffold with advancing bioprinting technique is anticipated. The study’s plan and results have been registered with the Clinical Research Information Service (CRIS No. 3-2019-0306) and the Ministry of Food and Drug Safety (MFDS No.1182).
참고문헌 (22)
- Tanzer RC, "Total reconstruction of the external ear", Plast Reconstr Surg Transplant Bull, 23, pp.1~15 (1959)
- Brent B, "Ear reconstruction with an expansile framework of autogenous rib cartilage", Plast Reconstr Surg, 53, pp.619~628 (1974)
- Nagata S, "A new method of total reconstruction of the auricle for microtia", Plast Reconstr Surg, 92, pp.187~201 (1993)
- Brent B, "Technical advances in ear reconstruction with autogenous rib cartilage grafts : personal experience with 1200 cases", Plast Reconstr Surg, 104, pp.319~334 (1999)
- Steffen A, "A prospective evaluation of psychosocial outcomes following ear reconstruction with rib cartilage in microtia", J Plast Reconstr Aesthet Surg, 63, pp.1466~1473 (2010)
- Kozusko SD, "The history of alloplastic ear reconstruction for microtia", Ann Plast Surg, 85, pp.89~92 (2020)
- Reinisch J, "Ear reconstruction in young children", Facial Plast Surg, 31, pp.600~603 (2015)
- Ma Y, "Systematic review of Medpor versus autologous ear reconstruction", J Craniofac Surg, 33, pp.602~606 (2022)
- Reighard CL, "Auricular reconstruction from rib to 3D printing", J 3D Print Med, 2, pp.35~41 (2018)
- Arif ZU, "Recent advances in 3D-printed polylactide and polycaprolactone-based biomaterials for tissue engineering applications", Int J Biol Macromol, 218, pp.930~968 (2022)
- Ghilan A, "Trends in 3D printing processes for biomedical field : opportunities and challenges", J Polym Environ, 28, pp.1345~1367 (2020)
- Dwivedi R, "Auricular reconstruction via 3D bioprinting strategies : an update", J Oral Biol Craniofac Res, 12, pp.580~588 (2022)
- Zhou G, "In vitro regeneration of patient-specific ear-shaped cartilage and its first clinical application for auricular reconstruction", EBioMedicine, 28, pp.287~302 (2018)
- Chen HY, "Pursuing mirror image reconstruction in unilateral microtia : customizing auricular framework by application of three-dimensional imaging and three-dimensional printing", Plast Reconstr Surg, 139, pp.1433~1443 (2017)
- Jung BK, "Ideal scaffold design for total ear reconstruction using a three-dimensional printing technique", J Biomed Mater Res B Appl Biomater, 107, pp.1295~1303 (2019)
- Joo OY, "Fabrication of 3D-printed implant for two-stage ear reconstruction surgery and its clinical application", Yonsei Med J, 64, pp.291~296 (2023)
- Dwivedi R, "Polycaprolactone as biomaterial for bone scaffolds : review of literature", J Oral Biol Craniofac Res, 10, pp.381~388 (2020)
- Lee JS, "Three-dimensional cell printing of large-volume tissues : application to ear regeneration", Tissue Eng Part C Methods, 23, pp.136~145 (2017)
- Otto IA, "Biofabrication of a shape-stable auricular structure for the reconstruction of ear deformities", Mater Today Bio, 9, pp.100094~ (2021)
- Yu J, "Fabrication of a polycaprolactone", alginate bipartite hybrid scaffold for osteochondral tissue using a three-dimensional bioprinting system, 2020, pp.12, 2203~
- Woodruff MA, "The return of a forgotten polymer—polycaprolactone in the 21st century", Prog Polym Sci, 35, pp.1217~1256 (2010)
- Lewin S, "Complications after total porous implant ear reconstruction and their management", Facial Plast Surg, 31, pp.617~625 (2015)