title: Three-dimensional autologous cartilage framework fabrication assisted by new additive manufactured ear-shaped templates for microtia reconstruction.
abstract: BACKGROUND
  During microtia reconstruction, the intraoperative design of the cartilage framework is important for the appearance and symmetry of the bilateral auricles. Templates (traditionally, the X-ray film template) are usually utilized to complete the task, which can provide cues regarding size, cranioauricular angle and positioning to the surgeons. With a combination of three-dimensional (3D) scanning and additive manufacturing (AM) techniques, we utilized two different ear-shaped templates (sheet moulding and 3D templates) during the fabrication of 3D-customized autologous cartilage frameworks for auricle reconstruction.
  
  
  METHODS
  Forty unilateral microtia patients were included in the study. All the patients underwent auricle reconstruction using the tissue-expanding technique assisted by the new AM templates. Images were processed using computer-aided design software and exported to print two different AM ear-shaped templates: sheet moulding and 3D. Both templates were assisted by the 3D framework fabrication. The 3D images of each patient's head were captured preoperatively using a 3D scanner. X-ray film templates were also made for the patients. The lengths and widths of the contralateral auricles, X-ray film and sheet moulding templates were measured in triplicate. The error of the template and the contralateral auricle were used to compare the accuracy between the two templates.
  
  
  RESULTS
  Between January and May 2014, 40 unilateral microtia patients aged 6-29 years were included in this study. All patients underwent auricle reconstruction using autogenous costal cartilage. The sterilized AM templates were used to assist in the framework fabrication. The operative time was decreased by an average of 15 min compared with the method assisted by the X-ray film template. Postoperative appearance evaluation (based on five indexes: symmetry, length, width, cranioauricular angle and the substructure of the reconstructed ear) was performed by both the doctors and the patients (or their parents). Follow-up (ranging from 9 to 18 months) showed that all of the patients obtained satisfactory results with life-like 3D configuration and symmetric cranioauricular angle. The follow-up showed that no surgery-related complications occurred. Comparing the accuracy of the X-ray film and sheet moulding templates, the average errors of length were 1.8 mm ± 1.44 mm and 0.39 mm ± 0.35 mm, respectively, and the average width errors were 1.32 mm ± 0.88 mm and 0.3 mm ± 0.47 mm, respectively. The new sheet moulding template was more accurate than the X-ray template.
  
  
  CONCLUSIONS
  The new sheet-moulding template is much more accurate than the traditional X-ray film template. Framework fabrication assisted by accurate 3D and informative AM templates contributed to individualized cartilage framework fabrication and satisfactory results.
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Jiayu
authors: J
authors: Zhou
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Bo
authors: B
authors: Pan
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Qinghua
authors: Q
authors: Yang
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Yanyong
authors: Y
authors: Zhao
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Leren
authors: L
authors: He
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Lin
authors: L
authors: Lin
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Hengyun
authors: H
authors: Sun
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Yupeng
authors: Y
authors: Song
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Xiaobo
authors: X
authors: Yu
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China.
authors: Zhongyang
authors: Z
authors: Sun
authors: The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing 100144, China. Electronic address: jianghaiyue_psh@163.com.
authors: Haiyue
authors: H
authors: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D002681:China; D017076:Computer-Aided Design; D065817:Congenital Microtia / Q000601:surgery*; D054644:Ear Auricle / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013518:Surgery, Plastic / Q000379:methods; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000379:methods*; D016896:Treatment Outcome
keywords: Additive manufacturing; Auricular reconstruction; Ear-shaped template; Framework fabrication; Microtia; Three-dimensional scanning