RESUMEN
BACKGROUND: The design of custom contoured cushions manufactured in flexible polyurethane foams is an option to improve positioning and comfort for people with disabilities that spend most of the day seated in the same position. These surfaces increase the contact area between the seat and the user. This fact contributes to minimise the local pressures that can generate problems like decubitus ulcers. The present research aims at establishing development routes for custom cushion production to wheelchair users. This study also contributes to the investigation of Computer Numerical Control (CNC) machining of flexible polyurethane foams. METHOD: The proposed route to obtain the customised seat began with acquiring the user's contour in adequate posture through plaster cast. To collect the surface geometry, the cast was three-dimensionally scanned and manipulated in CAD/CAM software. CNC milling parameters such as tools, spindle speeds and feed rates to machine flexible polyurethane foams were tested. These parameters were analysed regarding the surface quality. The best parameters were then tested in a customised seat. The possible dimensional changes generated during foam cutting were analysed through 3D scanning. Also, the customised seat pressure and temperature distribution was tested. RESULTS: The best parameters found for foams with a density of 50kg/cm(3) were high spindle speeds (24000 rpm) and feed rates between 2400-4000mm/min. Those parameters did not generate significant deformities in the machined cushions. The custom contoured cushion satisfactorily increased the contact area between wheelchair and user, as it distributed pressure and heat evenly. CONCLUSION: Through this study it was possible to define routes for the development and manufacturing of customised seats using direct CNC milling in flexible polyurethane foams. It also showed that custom contoured cushions efficiently distribute pressure and temperature, which is believed to minimise tissue lesions such as pressure ulcers.
RESUMEN
Um material adequado para a reconstrução óssea craniofacial deve ser simples de implantar, possuir forma adequada, resistência à fratura e à deformação similares ao osso original, ser eventualmente substituído por osso natural, ser largamente disponível e não possuir um custo muito elevado. Baseado no fato de que um material com todas estas características ainda não está disponível atualmente, torna-se importante buscar novos materiais, novas composições e novas conformações. Diferentes biomateriais são utilizados atualmente para cirurgias de reconstrução craniofacial, cada um apresentando suas vantagens e limitações. Entre eles destacam-se o titânio, o polimetilmetacrilato e os cimentos de fosfato de cálcio. O titânio apresenta difícil conformação; o polimetilmetacrilato polimeriza-se por meio de uma reação exotérmica, podendo causar necrose de tecidos adjacentes ao implante; o cimento de fosfato de cálcio, por sua vez apresenta certa fragilidade, característica de alguns materiais cerâmicos. Neste sentido, este estudo examinou diferentes materiais utilizados para reconstrução craniofacial e suas propriedades mecânicas quando submetidos a ensaios de flexão, como o polimetilmetacrilato, o cimento de fosfato de cálcio e o cimento de fosfato de cálcio reforçado com titânio. Foi verificada a melhoria de propriedades mecânicas do cimento de fosfato de cálcio quando reforçado com malha de titânio. Além disso, este estudo apresenta uma técnica para o projeto e fabricação de implantes craniofaciais personalizados utilizando cimento de fosfato de cálcio reforçado com titânio, validada através de quatro casos de indicação cirúrgica de reconstrução craniofacial.
A material suitable for craniofacial reconstruction must be easy to implant, have the appropriate shape, have the strength and deformation similar to the original bone, be eventually substituted for natural bone, be widely available and present affordable costs. As such as material, with all theses characteristics is still not available, it is important to search for new materials, new compositions and new design. Different biomaterials are used nowadays for craniofacial reconstruction surgeries, each one presenting its advantages and limitations. Among these materials are the titanium, the poli(methilmetacrilate) and the calcium phosphate cements. Titanium presents hard conformation; poli(methilmetacrilate)s polymerization reaction is exothermic, which may cause necrosis of the adjacent tissues; calcium phosphate cement is brittle, an usual characteristic of ceramic materials. In this way, this study evaluated different materials used for craniofacial reconstruction and its mechanical properties when submitted to bending test, such as poli(methilmetacrilate), calcium phosphate cement and calcium phosphate cement reinforced with titanium. It was verified the improvement in the mechanical properties of the calcium phosphate cement when reinforced with titanium mesh. In addition, this study presents a method for design and manufacturing of customized craniofacial implants using calcium phosphate cement reinforced with titanium mesh, validated through four cases of craniofacial reconstruction surgery indication.