title: Three-Dimensional Printing in Plastic and Reconstructive Surgery: A Systematic Review.
abstract: BACKGROUND
  Increasingly affordable three-dimensional (3D) printing technologies now make it possible for surgeons to create highly customizable patient-tailored products. This process provides the potential to produce individualized artificial and biologic implants, regenerative scaffolds, and cell-specific replacement tissue and organs. The combination of accurate volumetric analysis and production of 3D printed biologic materials are evolving techniques that demonstrate great promise in achieving an accurate and naturally appearing anthropomorphic reconstruction. This systematic review summarizes the current published literature and known ongoing research on 3D printing in the field of plastic and reconstructive surgery (PRS).
  
  
  METHODS
  Three medical databases (PubMed, Ovid MEDLINE, and Google Scholar) as well as recent news articles and university websites were searched using PRS and industry-related search terms. Inclusion criteria consisted of any publication or reputable news or academic article in electronic or printed media directly studying or commenting on the use of 3D printing technology in relation to PRS. The current literature was critically appraised, and quality of selected articles was assessed and manually filtered for relevance by 2 reviewers.
  
  
  RESULTS
  A total of 1092 articles were identified from the aforementioned sources discussing 3D printing in medicine. The 3D printing in relation to biologic and surgical applications was discussed in 226 articles. Within this subset, 103 articles were included in the review. Of those selected, 5 were pertinent to surgical planning, training, and patient education; 4 to upper extremity and hand prosthetics; 24 to bone and craniomaxillofacial (CMF) reconstruction; 10 to breast reconstruction; 20 to nose, ear, and cartilage reconstruction; 20 to skin; and finally 20 involving overlapping general topics in 3D printing and PRS.
  
  
  CONCLUSIONS
  The 3D printing provides the ability to construct complex individualized implants that not only improve patient outcomes but also increase economic feasibility. The technology offers a potential level of accessibility that is paramount for remote and resource-limited locations where health care is most often limited. The 3D printing-based technologies will have an immense impact on the reconstruction of traumatic injuries, facial and limb prosthetic development, as well as advancements in biologic and synthetic implants.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Bauermeister
authors.forename: Alexander
authors.initials: A
authors.lastname: Zuriarrain
authors.forename: Martin I
authors.initials: MI
authors.lastname: Newman
mesh_terms: D006801:Humans; D008953:Models, Anatomic; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods; D066330:Printing, Three-Dimensional; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D054457:Tissue Scaffolds