title: Cranioplasty Enhanced by Three-Dimensional Printing: Custom-Made Three-Dimensional-Printed Titanium Implants for Skull Defects.
abstract: The authors studied to demonstrate the efficacy of custom-made three-dimensional (3D)-printed titanium implants for reconstructing skull defects. From 2013 to 2015, 21 patients (8-62 years old, mean = 28.6-year old; 11 females and 10 males) with skull defects were treated. Total disease duration ranged from 6 to 168 months (mean = 33.6 months). The size of skull defects ranged from 84 × 104 to 154 × 193 mm. Custom-made implants were manufactured by Medyssey Co, Ltd (Jecheon, South Korea) using 3D computed tomography data, Mimics software, and an electron beam melting machine. The team reviewed several different designs and simulated surgery using a 3D skull model. During the operation, the implant was fit to the defect without dead space. Operation times ranged from 85 to 180 minutes (mean = 115.7 minutes). Operative sites healed without any complications except for 1 patient who had red swelling with exudation at the skin defect, which was a skin infection and defect at the center of the scalp flap reoccurring since the initial head injury. This patient underwent reoperation for skin defect revision and replacement of the implant. Twenty-one patients were followed for 6 to 24 months (mean = 14.1 months). The patients were satisfied and had no recurrent wound problems. Head computed tomography after operation showed good fixation of titanium implants and satisfactory skull-shape symmetry. For the reconstruction of skull defects, the use of autologous bone grafts has been the treatment of choice. However, bone use depends on availability, defect size, and donor morbidity. As 3D printing techniques are further advanced, it is becoming possible to manufacture custom-made 3D titanium implants for skull reconstruction.
authors.affiliation: *Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine †School of Biomedical Engineering, Yonsei University ‡Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul §School of Biomechanical Engineering, Inje University, Gimhae, Korea.
authors.forename: Eun-Kyung
authors.initials: EK
authors.lastname: Park
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Lim
authors.forename: In-Sik
authors.initials: IS
authors.lastname: Yun
authors.forename: Ju-Seong
authors.initials: JS
authors.lastname: Kim
authors.forename: Su-Heon
authors.initials: SH
authors.lastname: Woo
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
mesh_terms: D000293:Adolescent; D000328:Adult; D000497:Alloys; D001672:Biocompatible Materials; D001927:Brain Diseases / Q000601:surgery*; D002648:Child; D017076:Computer-Aided Design; D006259:Craniocerebral Trauma / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011183:Postoperative Complications / Q000601:surgery; D066330:Printing, Three-Dimensional; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012886:Skull / Q000601:surgery*; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000497:Alloys; D001672:Biocompatible Materials; C031462:titanium alloy (TiAl6V4); D014025:Titanium