title: [Correction of congenital malformations by custom-made silicone implants: Contribution of computer-aided design. Experience of 611 cases].
abstract: BACKGROUND
  Modern techniques of computer-aided design and tridimensional prototyping for manufacturing silicone elastomer custom implants are growing. They have widely modified the surgical indications in our unit.
  
  
  METHODS
  By presenting their experience of 611 cases managed between 1993 and 2016, the authors describe the method of conception from CT-scans, the virtual image of the body and the manufacture of the custom-made implant perfectly adapted to the anatomy of each one. The operative techniques are described for the three main indications: the funnel chest or pectus excavatum (474 cases) according to a modified CHIN classification is corrected simply and very satisfactorily. This approach may render thoracic surgery techniques obsolete. Indeed, these operations remain risky and of doubtful functional utility; Poland syndrome (116 cases), where the use of a custom-made implant for compensation of muscle volume is frequently used, but can be improved by a transfer of adipose tissue or a classic breast implant; the leg atrophies (21 cases) receive custom elastomer implants introduced in a sub-fascial plane.
  
  
  RESULTS
  The results are excellent for pectus excavatum but more difficult to optimize for the other two indications, requiring sometimes complementary techniques. Complications are rare and often benign, implants endure for life. Quality of life, psychological comfort and self-esteem have been improved with low morbidity and without having undergone a painful surgical experience.
  
  
  CONCLUSIONS
  Reconstructive procedures of congenital malformations by custom-made silicone implants open a new field of activity for our surgical specialty with vast opportunities.
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Toulouse Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Chavoin
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Toulouse Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: benoitchaput31@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Chaput
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Toulouse Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: I
authors.initials: I
authors.lastname: Garrido
authors.affiliation: Anatomik Modeling SAS, 31000 Toulouse, France.
authors.forename: B
authors.initials: B
authors.lastname: Moreno
authors.affiliation: Service de chirurgie thoracique, CHU de Toulouse Larrey, 24, chemin de Pouvourville, 31000 Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Service de chirurgie plastique et reconstructrice, CHU de Toulouse Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Grolleau
mesh_terms: D001284:Atrophy; D017076:Computer-Aided Design; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery*; D008297:Male; D011045:Poland Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D019736:Prostheses and Implants; D011474:Prosthesis Design / Q000379:methods*; D012826:Silicone Elastomers; D014057:Tomography, X-Ray Computed
chemical_list: D012826:Silicone Elastomers
keywords: Computer-aided design; Conception assistée par ordinateur; Congenital malformations; Custom-made implant; Implant sur mesure; Malformations congénitales; Silicone