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[News] Doctors use 3-D printer to custom-design implant for baby
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Doctors use 3-D printer to custom-design implant for baby
Doctors use 3-D printer to custom-design implant for baby

by Liz Szabo, USA TODAY

[Image: 9fcca11c-b9c3-4cd0-8642-377b68099f9b-panel-one.gif]

Researchers at the University of Michigan have used a 3-D printer to create a custom-made, life-saving implant for baby boy, they report in a letter in 'The New England Journal of Medicine.'

The baby, Kaiba Gionfriddo, suffered from a rare disorder in which one of the airways in his lungs collapsed when he exhaled. The problem caused him to stop breathing and turn blue when he was only 6 weeks old. Even with a mechanical ventilator, Kaiba stopped breathing virtually every day, requiring doctors to perform emergency resuscitations.

"We'd recently had a child in the hospital who died of this, and I said, 'there has got to be a solution that we can find for these kids,' " says co-author Glenn Green, Kaiba's doctor and an associate professor of otolaryngology.

So Green and his Michigan colleagues tried something new.

Using a 3-D printer, they custom-built a tiny, flexible splint that will grow with Kaiba. Researchers used a special material designed to be absorbed by Kaiba's body in about three years, says co-author Scott Hollister, a professor of biomedical and mechanical engineering.

Instead of making a cast of Kaiba's airway with plaster, they used a CT scanner, which gave them a 3-D blueprint.

Like a vacuum-cleaner hose, the C-shaped splint is flexible enough to move when Kaiba breathes. But it's also firm enough to prevent his air tube from flopping shut, says Green.

Kaiba was able to come off the ventilator three weeks after his surgery in February 2012. "Our prediction is that this will be a cure for him," Green says. "The splint will go away and the process will be done."

The porous splint is made from the same material as dissolvable stitches, Green says. Just as a wisteria vine grows through a trellis, Kaiba's body will create new cells to permeate the scaffold. By the time the splint is completely absorbed, doctors hope that Kaiba's own tissue will be sturdy enough to keep his airway open.

By then, Kaiba will be big enough to withstand a slight narrowing of the bronchus, Green says. As a newborn, the bronchus was so narrow that even a slight collapse was enough to completely block air flow.

About one in 2,200 babies are born with Kaiba's condition, called tracheobronchomalaci. Most grow out of it by age 2 or 3.

Now 19 months old, Kaiba is breathing well, although he still has a tracheostomy tube, which allows air into his windpipe, says his mother, April Gionfriddo, of Youngstown, Ohio.

"We're really relieved and happy that he's not turning blue anymore," says Gionfriddo, noting that Kaiba has battled multiple complex health problems, including a hernia, asthma and anatomic defects in several blood vessels. He also underwent surgery to treat hydrocephalus, in which fluid presses on the brain.

Other surgeons praised the Michigan team's ingenuity.

"It's hugely fascinating," says Sidhu Gangadharan, chief of thoracic surgery at Beth Israel Deaconess Medical Center in Boston, who wasn't involved with Kaiba's care. "They had a really unique problem and they came up with a unique solution."

Gangadharan says his hospital will likely follow the researchers' example in custom designing medical devices with 3-D printers Because Kaiba's life was in immediate jeopardy, the Food and Drug Administration gave doctors emergency clearance to produce the device. The 3-D printer allowed doctors to design and produce the splint quickly, Hollister says. The printers work somewhat like inkjet printers. But instead of squirting out layers of ink, the printer lays down layers of the biopolymer.

Doctors are now planning a clinical trial in order to create additional splints for children whose condition isn't immediately life-threatening.

The same technology could be used to custom engineer a variety of implants, such as facial bones, Hollister says. He and Green already have built ears and noses, based on patient scans, although these have not yet been transplanted into people.

Scientists are already using 3-D printers to build scaffolds for tissue engineering, with the aim of making blood vessels and other replacement body parts, says Anthony Atala, the Director of the Wake Forest Institute for Regenerative Medicine in North Carolina.

Atala uses a 3-D printer to lay down a cell-filled gel, layer by layer. The gel protects the cells from being damaged in the printing process, but it also hardens into a scaffold, Atala says. Substances in the gel provide food for the cells to grow.

These custom-made blood vessels — so far used only in animals — could be used in bypass surgery, Atala says. They could also be used to replace blocked blood vessels in the legs, or provide blood vessels to patients undergoing kidney dialysis. Atala also has used tissue engineering to create bladders for patients.

Researchers are also using these techniques to develop cartilage-based organs such as ears and tracheas. Researchers at Princeton University recently used a 3-D printer to create a functional bionic ear.

In April, doctors at the University of Illinois in Peoria gave a 2-year-old girl a new windpipe, which was grown from stem cells seeded on a plastic scaffold.

[Image: 1369176786000-XXX-KAIBA-GIONFRIDDO-SURGE...bfaead0983]
Doctors used a 3-D printer to create a tiny, bioresorbable scaffold like this one to implant in Kaiba Gionfriddo's windpipe to keep it from collapsing.(Photo: University of Michigan)

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05-22-2013 10:37 PM
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PaulaO2 Offline
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Post: #2
RE: Doctors use 3-D printer to custom-design implant for baby
My thoughts on this is I wonder if they can make something similar as a treatment for sleep apnea.

We could still swallow, maybe even sing. But the airway would stay open. Not sure I would want to go through the procedure every 3 yrs though.

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05-23-2013 01:15 AM
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RE: Doctors use 3-D printer to custom-design implant for baby
You actually wouldn't have to - the absorption point would be slightly scarred and stronger, less prone to collapse. They do something similar already when the collapse point is the uvula and not the throat - three or four splints are inserted into the uvula, each around the size of the collar stiffeners used in men's shirts. these create a stiffer, yet still flexible uvula and limit how far the uvula can collapse into the mouth or throat. After time, they are absorbed by the body, but the scar tissue matrix is then strong enough to do the job on its own. I should caution you that this would work for very few apnoea cases of the type I am hearing about here, so don't go rushing out to your doc asking - it only works for very specific conditions, and most of us would not benefit from it. For adults, an implantable device in the throat would probably too stiff to be usable - we're far bigger and our tissue far more heavy than an infant's. The size and weight of a device like the one shown above would be too much for our comfort, if nothing else. Still, you never know - some bright Aussie doctor will probably give it a go anyway, after seeing this article. It seems they "own" apnoea the way the Swedes "own" orthopaedics and the Montrealers "own" neurosurgery.

At the Unispital and Inselspital, they've been using 3D printers to create body parts for a few years now, mostly implantable ears and other such scaffoldings. Pretty amazing stuff. Recently one doc built a new heart valve with one. I have heard of experiments here to built new livers by cloning healthy liver tissue from the patient, create a 3D scaffolding and "print" the liver using the cloned cells. Same for hearts. We live in a world of wonders, it is true.
05-23-2013 05:16 AM
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RE: Doctors use 3-D printer to custom-design implant for baby
The question that immediately comes to mind is; why did they need a 3D printer to make this? It sure seems to me that it could have been made fairly easily by conventional methods. I guess a 3D printer may have made it more convenient to manufacture; but the tone of the story implies that the 3D printer is what made it possible - am I missing something? If it weren't for a 3D printer, would they have been unable to provide this treatment because it would have been too difficult to mold or machine this device? I doubt it, but maybe I'm missing something...

EDIT: Speed of manufacture - I was missing something.

This should teach me to finish reading the WHOLE story before commenting.
(This post was last modified: 05-23-2013 01:23 PM by jgjones1972.)
05-23-2013 01:19 PM
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Sleepster Offline
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Post: #5
RE: Doctors use 3-D printer to custom-design implant for baby
I understood that the shape of the implant was critical. Instead of making a plaster cast they used the 3-D image from a CT scan. I suppose that it could have been crafted by hand matching its shape to that of the CT scan, but the technology is already there to do it using the printer so perhaps that was the easier way to do it. Definitely more precise.

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05-23-2013 03:19 PM
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RE: Doctors use 3-D printer to custom-design implant for baby
Speed here was of the essence, as was accuracy, and for that a 3D printer shaved not just hours, nor days, but weeks in comparison to making a cast and physical model by hand or milling machine.
05-23-2013 03:27 PM
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RE: Doctors use 3-D printer to custom-design implant for baby
My mother just had a knee replacement. Due to various stuff, they decided to do a 3D fitting of the new joint. They used the 3D image of her bones then made the knee ends to fit them. This eliminated the time spent in surgery since it was build to fit right over the existing bone and it ensured it fit in the small amount of useable bone.

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05-23-2013 08:58 PM
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RE: Doctors use 3-D printer to custom-design implant for baby
Yep! We live in a world of marvels! For that operation, back when I was learning the trade, there were hours and hour of sawing and drilling to get the leg to fit the prosthesis, now it is relatively fast and we make the prosthesis fit the leg. I remember that ortho cutters were distinguished by their brawn - of all the jocks in the OP, the orthos were the jockiest, big shoulders and arms, because of all the hammering and sawing, which other cutters didn't do. Not true anymore - so much is done beforehand to ensure a perfect fit that all the heavy hammering is at a minimum. Every week I am confronted with a new technique or technology that replaces fifty years or more of methodology and I am astounded. A real age of miracles. We're heading for the Star Trek era in medicine, that's for sure. Last month I was at a demo of a new laser suture technique that may make for scarless skin closures in the future, and self absorbing bio sutures for under the skin to close surgical wounds without any inner scarring. Amazing stuff.

I had a chat with a colleague the other week about creating a new type of air delivery system directly into the nose without all these hoses and big compressors. He's a mechanical genius, so I'll let you know what eh comes up with. Who knows, in a few years you'll all be wearing nose plugs by Eynar instead of masks and S9s.....
05-24-2013 04:54 AM
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