Surgical Design Case Study 1 - Post-Traumatic Zygomatic Osteotomy & Orbital Floor Reconstruction
AT: PDR
FOR: NHS
MY ROLE: RESEARCH PROJECT MANAGER / DESIGNER
PEER-REVIEWED REPORT AVAILABLE AT: RAPID PROTOTYPING JOURNAL / CARDIFF MET. REPOSITORY
BBC Coverage
Clinical Background
A motorcyclist who was severely injured in an accident underwent pioneering surgery using techniques developed by the Surgical & Prosthetic Design team at PDR, Cardiff Metropolitan University and the Maxillofacial Unit at Morriston Hospital.
The patient was motorcycling with friends, when he was involved in an accident in Llantwit Major, near Cardiff. He broke both arms and his right leg was so badly damaged it required a bone graft. He also suffered major injuries to his head and face. He underwent emergency surgery at Morriston Hospital, Swansea. His limb injuries were very serious and were managed by the trauma and orthopaedic surgeons and the plastic surgeons.
Surgical Aims
The goal of the revision surgery, led by Consultant Maxillofacial Surgeon Mr Adrian Sugar, was primarily to correct the patient’s appearance by precisely cutting and moving facial bones. This represented a significant challenge due to the complexity of the necessary movements and proximity of the operation to critical, sensitive anatomy. In order to offer the optimum outcome, a multidisciplinary approach that utilised the latest surgical planning, computer aided design and 3D printing techniques was required.
Design
I assisted the Morriston team in transforming the medical scan data of the patient into a virtual, 3D surgical model. Precise locations for cuts that would free up sections of facial bone for movement were then decided upon in close collaboration with the clinicians. In order to translate these cuts into theatre, a custom fitting saw guide was designed to fit securely around the anatomy, with slots positioned to guide the surgeon’s movement.
Once the bone sections were freed in the virtual plan, they were carefully positioned to reconstruct the anatomy and provide the best possible symmetry. Custom implants, and a repositioning guide to enable the bone sections to be held securely whilst the implants were placed, were then designed.
Results
Mr Sugar led a multidisciplinary team that included ENT surgeon, Serryth Colbert, registrar, Ali Al-Rikabi, further theatre staff, and prosthetists Peter Evans and Lawrence Dovgalski. The 8 hour operation went smoothly, with the guides and implants fitting according to the plan. Recovery has gone well since the operation and the swelling gradually reduced, revealing the final outcome.
This represented a world-first application of digital design and AM to all stages of this surgical procedure. Having established key design rules after evaluating prototypes and alternative plans, I established a standard operating procedure which allowed subsequent similar cases to be delivered efficiently and as a matter of routine.
