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Pre-operative soft tissue model produced on the Objet500 Connex3 Multi-material Color 3D Printer using flexible TangoPlus Material

Stratasys Helps Put a New Face on Transplant Surgery

Dr. Frank J. Rybicki, Brigham and Women’s Hospital, uses 3D printing to visualize soft facial tissue during pre-operative analysis.
Dr. Frank J. Rybicki, Brigham and Women’s Hospital, uses 3D printing to visualize soft facial tissue during pre-operative analysis.

The impact of Stratasys 3D printing on medical procedures is nothing short of revolutionary. From surgical guides to organ models that reduce surgery times and improve accuracy, we hear of new breakthroughs nearly every day. Among the most dramatic is a full facial transplant based on 3D printing.

Restoring basic facial functions with a full face transplant

A full face transplant is a complex medical procedure that goes far beyond standard cosmetic surgery. “It is considered among the most relevant surgical innovation in the last 200 years,” noted, Dr. Frank J. Rybicki, Director, Applied Imaging Science Laboratory at Brigham and Women’s Hospital (BWH). That’s the hospital that pioneered full-facial transplant procedures in the United States and has already treated seven transplant recipients. As Dr. Rybicki puts it, “Fundamentally, the face comes off of the donor and goes on to the recipient.”

For the recipient, it’s not just a matter of a change in appearance, but the opportunity to regain facial functions that have been lost. The procedure allows people whose faces have been severely damaged to not only restore normal appearance but to restore basic functions, like eating, speaking, blinking and even breathing.  Just like any essential organ transplant, getting a new face to replace one that has lost its functionality really gives a person his or her life back.

The role of 3D modeling

Pre-operative soft tissue model produced on the Objet500 Connex3 Multi-material Color 3D Printer using flexible TangoPlus Material
Pre-operative soft tissue model produced on the Objet500 Connex3 Multi-material Color 3D Printer using flexible TangoPlus Material

“3D printing is an emerging, disruptive technology in medicine, and radiologists are beginning to capitalize on the benefits of generating 3D models from standard radiology images such as CT scans, ” Dr. Rybicki explained. 3D printing now plays an essential role in the procedure, replicating each person’s individual facial bone structure, enabling surgeons to hold the model in their own hands for more precise surgical planning.

3D printing soft tissues

While we’ve seen 3D printed skulls used as surgical guides before, the surgical team at Brigham and Women’s Hospital is advancing 3D modeling even further with 3D printed soft tissues.  The first full transplant to make use of those models is one for a woman whose face was disfigured by an attack with industrial-strength lye. Though her bone structure remained intact, her facial tissues were damaged.  This is the first report of 3D printing the soft tissue for this type of surgery and the BWH team is using the models to better understand “…the state of the soft tissues at various stages in time” Dr. Rybicki said.

It takes a number of steps to get from CT images of the patient to full 3D printed models of the essential parts for the full face transplant. The images are archived in DICOM (Digital Imaging and Communications in Medicine) format. These images are then converted into STL files using software tools from Materialise and are ready for 3D printing. Using flexible TangoPlus material on an Objet500 Connex3 Multi-material Color 3D Printer, the surgical team 3D printed the soft tissues both before and after the patient’s face transplant. With a total build time of approximately 19 hours for both pre- and post-operative soft tissue,  the surgeons are now able to get a much clearer picture of what the patient will look like post surgery.

The advantage of 3D printing the soft tissue is that it gives the surgeons a “better understanding of what’s between the skin and bones” better than any two dimensional representation and the ability to accurately record changes.

“We’re going to show those dramatic changes in tissues in a novel method that have been previously unavailable. While the contours can be in part perceived with photography, there is no substitute for holding the tissues in your hands.”

Groundbreaking visualization aids a complex procedure

Post-operative soft tissue model produced on the Objet500 Connex3 Multi-material Color 3D Printer using flexible TangoPlus Material
Post-operative soft tissue model produced on the Objet500 Connex3 Multi-material Color 3D Printer using flexible TangoPlus Material

Dr. Rybicki explained that bringing the 3D-printed models of the bones structure together with the soft tissue 3D printed into a single piece gives an unprecedented view of how the full transplant will fit. “With a second printed model of the bones of the skull, the soft tissues can be manipulated and studied like a mask.”

The skull used for this surgery was printed on an Objet Eden 260VS 3D Printer with rigid VeroWhite material. It gives the surgeons the ability to see what the final results will look like, though the surgical procedure itself can take 15 hours or more to work through the many intricate connections in the face.

This groundbreaking use for 3D printing in the surgical field is going to help ensure that these connections are put exactly where the surgeon needs them, since they are now being planned prior to the surgery.

Watch an exclusive interview with Dr. Rybicki here.

This post is also available in: German

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2 comments

  • I gave a presentation on additive manufacturing (3D Printing) for a class last year. At the time, no one that I know of was able to print soft tissue. I’m very excited to see that Dr. Rybicki and BWH are taking advantage of this new technology and applying it in a way that will help people.
    3D Printing is changing the world right now. I hope to be a part of that in the near future.

    • To be clear, we did not bio-print the soft tissue, we printed the surgical guides to mimic the soft tissue when applied to the 3D Printed Skull.

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