CLINICAL APPLICATION OF 3D PRINTING TECHNOLOGY FOR PREOPERATIVE PLANNING OF THUMB RECONSTRUCTION

XU, LIN; TAN, JIA; WEI, PINGOU; LUO, XIANG; TAN, HAITAO; MUDGAL, CHAITANYA SHAMSUNDER

doi:10.1590/1413-785220212904235492

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Acta Ortopédica Brasileira

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ORIGINAL ARTICLE, WRIST AND HAND • Acta ortop. bras. 29 (4) • Jul-Aug 2021 • https://doi.org/10.1590/1413-785220212904235492 copy

CLINICAL APPLICATION OF 3D PRINTING TECHNOLOGY FOR PREOPERATIVE PLANNING OF THUMB RECONSTRUCTION

APLICAÇÃO CLÍNICA DA TECNOLOGIA DE IMPRESSÃO 3D PARA PLANEJAMENTO PRÉ-OPERATÓRIO DE RECONSTRUÇÃO DE POLEGAR

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

This study aimed to explore the clinical application of preoperative precise design for 3D printing and thumb reconstruction, which could help manage the patients with thumb defect and achieve better function and appearance.

Methods:

This was a retrospective study of 20 patients who underwent the surgery of harvesting toe transplant and thumb reconstruction between January 2015 and December 2016. The 3D model of the thumb defect was created and printed. The dimensions of skin and bones from donor site were precisely designed as reference for surgical operation. The surgery was performed according to the model.

Results:

Perfect repair of defects was achieved with satisfying appearance and function. The reconstructed thumbs all survived (survival rate of 100%). Follow-up was 3-9 months. The maximum dorsiflexion was 8-30° and the maximum flexion was 38-58°. The two-point sensory discrimination was 9-11 mm. In total, 17 patients reposted “Excellent” satisfaction and three “Good”, each for the reconstructed thumb and hand function, respectively. The satisfaction rate was 85%.

Conclusion:

Preoperative digital design and 3D printing according to the donor and recipient sites allowed a tailored operation. The operation was more precise, the appearance of the reconstructed thumb was good. Level of Evidence II, Retrospective Study.

Keywords:
Finger Injuries; Bone Transplantation; Reconstructive Surgical Procedures; Printing; Three-Dimensional; Computer-Aided Design

Case	Age (years)	Degree of thumb defect	Defect of the first web	Length of required thumb (mm)	Width of healthy toe (mm)	Thickness of healthy digital pulp (mm)
1	22	I	Yes	32	16	15
2	23	II	Yes	31	15	14
3	29	IIIa	No	42	18	17
4	2	IIIa	No	22	12	12
5	34	IIIb	Yes	41	16	14
6	45	IIIa	No	37	17	15
7	28	IIIb	Yes	38	17	16
8	31	IIIa	Yes	31	13	12
9	44	II	No	32	14	14
10	27	IIIa	No	33	13	13
11	11	IIIa	Yes	31	14	13
12	38	IIIb	No	41	17	15
13	39	I	Yes	35	16	14
14	41	IIIa	No	44	17	15
15	29	IIIb	No	46	18	16
16	30	IIIa	Yes	46	17	15
17	33	II	No	32	14	14
18	29	IIIa	No	37	15	13
19	27	IIIa	Yes	38	16	13
20	21	IIIb	Yes	39	16	14

Case	Age (years)	Time of operation (h)	Length of reconstructed thumb (mm)	Width of nail (mm)	Thickness of digital pulp (mm)	Satisfaction
1	22	6.1	33	16	10	Excellent
2	23	6.2	30	15	9	Excellent
3	29	6,0	41	17	10	Excellent
4	2	5.9	25	13	8	Good
5	34	6.4	40	18	10	Excellent
6	45	6.1	36	16	11	Excellent
7	28	6.7	37	16	9	Excellent
8	31	6.9	32	15	10	Good
9	44	7.2	33	15	9	Excellent
10	27	6.8	32	15	10	Excellent
11	11	6.1	31	15	9	Excellent
12	38	6.7	40	18	10	Excellent
13	39	6.9	36	16	8	Excellent
14	41	7.2	43	18	10	Excellent
15	29	6.8	44	19	11	Good
16	30	6.1	45	19	9	Excellent
17	33	6.7	31	14	10	Excellent
18	29	6.9	35	14	9	Excellent
19	27	7.2	36	16	9	Excellent
20	21	6.8	37	15	9	Excellent

Case	Age (years)	Gilbert's classification of FDMA	Function of thumb opposing (cm)	Mobility of MP (angle of extension and flexion)	Two-point discrimination (mm)	Condition of using hand
1	22	Ia	0.9 (<1.0)	Extension 30˚, flexion 50˚	9	Excellent
2	23	IIb	1.5 (1.0-2.0)	Extension 21˚, flexion 55˚	10	Excellent
3	29	IIa	0.9 (<1.0)	Extension 20˚, flexion 38˚	11	Excellent
4	2	IIa	0.8 (<1.0)	Extension 11˚, flexion 40˚	9	Good
5	34	IIb	1.1 (1.0-2.0)	Extension 14˚, flexion 45˚	10	Excellent
6	45	IIa	1.5 (1.0-2.0)	Extension 10˚, flexion 58˚	11	Excellent
7	28	IIb	0.9 (<1.0)	Extension 8˚, flexion 40˚	9	Excellent
8	31	Ib	1.4 (1.0-2.0)	Extension 12˚, flexion 45˚	10	Good
9	44	Ia	0.5 (<1.0)	Extension 15˚, flexion 55˚	11	Excellent
10	27	IIa	0.0(<1.0)	Extension 28˚, flexion 40˚	9	Excellent
11	11	IIb	0.7 (<1.0)	Extension 30˚, flexion 45˚	10	Excellent
12	38	Ia	0.9 (<1.0)	Extension 10˚, flexion 50˚	11	Excellent
13	39	Ib	1.3 (1.0-2.0)	Extension 5˚, flexion 58˚	9	Excellent
14	41	IIb	1.5 (1.0-2.0)	Extension 10˚, flexion 40˚	10	Excellent
15	29	IIb	1.4 (1.0-2.0)	Extension 11˚, flexion 45˚	9	Good
16	30	IIa	1.3 (1.0-2.0)	Extension 7˚, flexion 55˚	9	Excellent
17	33	IIb	1.2 (1.0-2.0)	Extension 13˚, flexion 57˚	10	Excellent
18	29	Ia	1.1 (1.0-2.0)	Extension 20˚, flexion 38˚	11	Excellent
19	27	IIa	0.7 (<1.0)	Extension 27˚, flexion 55˚	9	Excellent
20	21	Ib	0.5 (<1.0)	Extension 18˚, flexion 45˚	9	Excellent

Case	Gender	Fellow-up (months)	Michigan Hand Outcomes Questionnaire						Strength
Case	Gender	Fellow-up (months)	General score (%)	Work score (%)	Pain score (%)	Appearance score (%)	Final score (%)	Michigan Hand Outcome Score (%)	Key pinch (%)	Grip power (%)
1	Male	6	25	25	50	18.8	16.7	26	45	39
2	Female	7	45	43	57	20.1	32.5	45	55	48
3	Male	9	66.2	44	64	20.1	32.9	43	43	35
4	Male	6	69.1	45	55	31.3	37.5	55	56	45
5	Male	7	40.1	34	52	22.4	20.4	32	55	43
6	Male	8	48.9	21	55	31.2	31.4	33	50	44
7	Male	6	52.4	29	58	29.1	30.1	37	51	48
8	Female	6	30.9	25	40	18.8	12,5	27	41	36
9	Male	8	33.2	37	41	27.1	18.4	29	41	32
10	Male	9	30.2	42	42	29.8	19.1	30	52	36
11	Male	6	37.7	44	38	27.4	21.8	32	43	42
12	Male	7	32.4	20	70	25.2	45.8	37	48	42
13	Female	6	36,4	38	73	27.3	44.3	39	50	46
14	Male	7	42.2	37	68	17.1	42.1	40	55	54
15	Male	9	42.9	26	64	19.1	47.2	44	48	32
16	Male	9	45.1	26	61	18.4	36.2	42	49	42
17	Male	6	45.0	37	57	25.2	28.1	40	41	49
18	Female	6	34.4	34	52	27.3	27.6	28	31	45
19	Male	6	45.2	42	61	17.1	32.7	29	39	31
20	Male	6	45.5	42	60	19.1	37.1	21	54	37

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[1] Correspondence:
Haitao Tan. Department of Hand & Foot Microsurgery, Guigang City People’s Hospital, Guigang 537100, Guangxi, China. tanhaitao99@hotmail.com