Can İhsan ÖZTORUN, Emrah ŞENEL, Atilla ŞENAYLI, Güven ÇANKAYA, Hakan OFLAZ

Clinical trials of 3D printing splints to avoid contracture development in burned children

Background/aim: We evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study. Materials and methods: After approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials’ significances and financial impact were evaluated statistically. Results: Seventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant. Conclusion: The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.Key words: Three dimension, printing, splint, children, burns, contracture

PDF

___

1. Grisbrook TL, Stearne SM, Reid SL, Wood FM, Rea SM et al. Demonstration of the use of the ICF framework in detailing complex functional deficits after major burn. Burns 2012; 38 (1): 32-43. doi.org/10.1016/j.burns.2011.04.001
2. Bills JD, Berriman SJ, Noble DL, Lavery LA, Davis KE. Pilot study to evaluate a novel three-dimensional wound measurement device. International Wound Journal 2015; 13 6): 1-6. doi.org/10.1111/iwj.12534
3. Paterson AM, Donnison E, Bibb RJ, Campbell RI. Computeraided design to support fabrication of wrist splints using 3D printing: A feasibility study. Hand Therapy 2014; 19 (4): 102– 113. doi.org/10.1177/1758998314544802
4. Willett AK. 3D Printing and Occupational Therapy: The process of 3D printing adaptive devices. Honor Thesis, University of Eastern Kentucky, USA, 2019.
5. Chow L, Yick KL, Kwan MY, Yuen CF, Ng SP et al. Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite. International Journal of Bioprinting 2020; 6(2):70-81. doi: 10.18063/ijb.v6i2.262.
6. Kadioğlu E, Aydin HE, Kaya I , Aydin N, Sahin MC. Manufacturing and application of personal hand and finger splint with three dimensional printer technology following hand and finger trauma. Annals Medical Research 2019; 26(8): 1474- 7. doi: 10.5455/annalsmedres.2019.05.286
7. Fozi MAA, Salleh MN, Ismail KA. Development of 3D-printed customized facial padding for burn patients. Rapid Prototyping Journal 2018; 25 (1): 55-61. doi: 10.1108/RPJ-09-2017-0179
8. Son J, Herrera-Valenzuela DS, Sacristán-Gutiérrez, MC, VargasCastellanos PM. An Update on Orthopedic Applications Using 3-Dimensional Printing Technologies. Revista Ingeniería Biomédica 2018; 12(23): 45-51. doi. org/10.24050/19099762.n23.2018.1079
9. Burn MB, Ta A, Gogola GR. Three-Dimensional Printing of Prosthetic Hands for Children. The Journal of Hand Surgery. 2016; 41(5): e103-e109. doi.org/10.1016/j.jhsa.2016.02.008
10. Benjamin NC, Lee JO, Norbury WB, Branski LK, Wurzer P et al. Accuracy of Currently Used Paper Burn Diagram vs a Three Dimensional Computerized Model. Journal of Burn Care & Research 2017; 38(1): e254–e260. doi.org/10.1097/ BCR.0000000000000363
11. Desbois A, Matei S, Perreault I, Beguet F, Gervais S et al. The importance of a 3D-based approach with personalized models for accurately assessing total body surface area. Journal of Burn Care & Research 2017; XXX: 1-10, doi: 10.1097/ BCR.0000000000000580.
12. Nam HS, Seo CH, Joo SY, Kim DH, Park DS. The Application of Three Dimensional Printed Finger Splints for Post Hand Burn Patients: A Case Series Investigation. Annals of Rehabilitation Medicine 2018; 42(4): 634-638. doi: 10.5535/arm.2018.42.4.634
13. Zweifel CJ, Guggenheim M, Jandali AR, Altintas MA, Kunzi W et al. Management of microstomia in adult burn patients revisited. Journal of Plastic, Reconstructive & Aesthetic Surgery 2010; 63 (4): e351-e357. doi.org/10.1016/j.bjps.2009.10.026
14. Soumya SV, Daniel SS, Ashish KG, Santosh K. Novel Use of Orthosis in a Case of Burn Contracture Microstomia. Journal of Maxillofacial and Oral Surgery 2016; 15(2): 281–284. doi: 10.1007/s12663-015-0830-1
15. Wei Y, Li-Tsang CWP. Rehabilitation of Patients with Facial Burn Injury: Principles and Practice Experiences. JSM Burns and Trauma 2017; 2(3): 1-5.
16. Pontini A, Reho F, Giatsidis G, Bacci C, Azzena B et al. Multidisciplinary care in severe pediatric electrical oral burn. Burns 2015; 41(3); e 41 – e46. doi.org/10.1016/j. burns.2014.12.006
17. Pilley MJ, Hitchens C, Rose G, Alexander S, Wimpenny DI. The use of non contact structured light scanning in burns pressure splint construction. Burns 2011; 37(7) 1168 – 1173. doi.org/10.1016/j.burns.2011.07.005
18. Kononova E, Nikitin M, Nikityuk I, Afonichev K ,Melchenko A. The post burn scar deformities of the foot in children. Evaluation of plantograms before and after reconstructive surgical treatment. Gait & Posture 2019; 73: 581–582. doi. org/10.1016/j.gaitpost.2019.07.284
19. Grishkevich VM. Ankle dorsiflexion postburn scar contractures: Anatomy and reconstructive techniques. Burns 2012; 38(16): 882 – 888. doi.org/10.1016/j.burns.2011.12.029
20. Grisbrook TL, Reid SL, Elliott CM, Elliott BC, Edgar DW et al. Lower limb functional outcome assessment following burn injury: A novel use for 3D laboratory-based movement analysis. Burns 2010; 36: e 24– e30. doi:10.1016/j.burns.2009.01.006
21. Palmieri TL, Petuskey K, Bagley A, Takashiba S, Greenhalgh DG et al. Alterations in Functional Movement After Axillary Burn Scar Contracture: A Motion Analysis Study. The Journal of Burn Care & Rehabilitation 2003; 24(2): 104–108. doi. org/10.1097/00004630-200303000-00008
22. Hawke F, Burns J. Brief Report: Custom Foot Orthoses for Foot Pain: What Does the Evidence Say? Foot & Ankle International 2012; 33: 1161-1163. doi.org/10.3113/FAI.2012.1161
23. Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database of Systematic Reviews. 2008; 1-113. doi.org/10.1002/14651858. CD006801.pub2
24. Dessery Y, Pallari J. Measurements agreement between lowcost and high level handheld 3D scanners to scan the knee for designing a 3D printed knee brace. PLOS ONE 2018; 13(1): e0190585. doi.org/10.1371/journal.pone.0190585
25. Li C, Cheung TF, Fan VC, Sin KM, Wong CWY et al. Applications of Three Dimensional Printing in Surgery. Surgical Innovation 2017; 24(1): 82 88. doi. org/10.1177/1553350616681889