Stereolithographic biomodelling in cranio-maxillofacial surgery: a prospective trial.

Stereolithographic (SL) biomodelling is a new technology that allows three-dimensional (3-D) computed tomography (CT) data to be used to manufacture solid plastic replicas of anatomical structures (biomodels). A prospective trial with the objective of assessing the utility of biomodelling in complex surgery has been performed. Forty-five patients with craniofacial, maxillofacial, skull base cervical spinal pathology were selected. 3-D CT or MR scanning was performed and the data of interest were edited and converted into a form acceptable to the rapid prototyping technology SL. The data were used to guide a laser to selectively polymerize photosensitive resin to manufacture biomodels. The biomodels were used by surgeons for patient education, diagnosis and operative planning. An assessment protocol was used to test the hypothesis that 'biomodels in addition to standard imaging had greater utility in the surgery performed than the standard imaging alone'. Biomodels significantly improved operative planning (images 44.09%, images with biomodel 82.21%, P < .01) and diagnosis (images 65.63%, images with biomodel 95.23%, P < .01). Biomodels were found to improve measurement accuracy significantly (image measurement error 44.14%, biomodel measurement error 7.91%, P < .05). Surgeons estimated that the use of biomodels reduced operating time by a mean of 17.63% and were cost effective at a mean price of $1031 AUS. Patients found the biomodels to be helpful for informed consent (images 63.53%, biomodels 88.54%, P < .001). Biomodelling is an intuitive, user-friendly technology that facilitated diagnosis and operative planning. Biomodels allowed surgeons to rehearse procedures readily and improved communication between colleagues and patients.

Stereolithographic (SL) biomodelling in craniofacial surgery.

BACKGROUND: Stereolithographic (SL) biomodelling allows 3D CT to be used to generate solid plastic replicas of anatomical structures (biomodels). Case reports in the literature suggest that such biomodels may have a use in craniofacial surgery but no large series or assessment of utility has been reported. A prospective trial to assess the utility of biomodelling in craniofacial surgery has been performed. METHODS: Forty patients with complex craniofacial abnormalities were selected and 3D CT scanning performed. The data of interest was used to guide a laser to selectively polymerise photosensitive resin to manufacture SL biomodels. The biomodels were used for patient education, diagnosis and operative planning. An assessment protocol was designed to test the hypothesis that biomodels in addition to standard imaging had greater utility in the surgery performed than the standard imaging alone. RESULTS: Anecdotally surgeons found biomodelling useful in 40 complex craniofacial operations. The formal assessment of the first 10 cases suggested biomodels improved operative planning (image 76%, image with biomodel 97%, P < 0.01) and diagnosis (image 82.5%, image with biomodel 99.25%, P < 0.01). Surgeons estimated that the use of biomodels had reduced operating time by a mean of 16% and were cost effective at a mean price of $1100 AUS. CONCLUSION: Biomodelling was reported as an intuitive, user-friendly technology that facilitated diagnosis, operative planning and communication between colleagues and patients. Limitations of the technology were manufacturing time and cost.

Reconstruction of aplasia cutis congenita of the scalp by split rib cranioplasty and a free latissimus dorsi muscle flap in a nine month old infant.

We present a case of reconstruction of severe aplasia cutis congenita. Initial treatment with silver sulphadiazine dressings failed and local scalp repair of the defect at age 3 months also failed to provide a stable reconstruction. At age 9 months the infant was experiencing increasing apparent hydrocephalus, shunt infection and brain herniation. The definitive reconstruction was performed with a split rib cranioplasty and a free latissimus dorsi muscle flap. The reconstruction was successful and the infant has a normal head shape and no neurological deficit 12 months postoperatively.

Surgical repair of myelomeningocele.

The birth of an infant with myelomeningocele provides a devastating experience for parents, a management dilemma for medical personnel, and an economic liability of immense proportions associated with the multiple disciplinary management program throughout the patient's life. Although undue delay in the onset of therapy is to be avoided, time can be taken for through assessment and appropriate discussion with the family without compromising the outcome. Once decisions are made to proceed with repair, early cover of the myelomeningocele defect is necessary to prevent progressive loss of neural tissue through exposure, desiccation, and sepsis. Many techniques of repair have been advocated. In principle, the ideal should be applicable to all sizes of defect, should be able to be executed in the neonatal age group with minimal morbidity, and should provide long-term, stable soft tissue cover without significant secondary scarring. A technique adhering to these principles is described and supported by results in a personal series of 84 patients during a 12-year period.

Common pitfalls in plastic surgery from the GP perspective.

General practitioners are responsible for the overall management of patients and their expertise is invaluable in this respect. With the ever changing horizons in disease processes and therapeutics, the dedicated family physician has more knowledge in general than many of his specialist colleagues. It is unfair, however, to expect general practitioners to have an in-depth knowledge of all conditions. These notes, I believe, offer family practitioners some beneficial information on possible pitfalls. My plastic surgeon colleagues would agree, I am sure, that further advice on any dilemma is merely a telephone call away.

Upper gastrointestinal haemorrhage-a review of 100 cases.

The case records of the last 100 consecutive patients with upper gastrointestinal tract bleeding admitted to the adult section of the Mater Misericordiae Hospital have been analysed with attention to presentation, investigations, aetiology, management and mortality. The period of these admissions was almost three years-from May, 1971, to June, 1974.