[Contribution of computer-aided design for the conception of custom-made implants in Pectus Excavatum surgical treatment. Experience of the Nantes plastic surgery unit]. / Apport de la conception assistée par ordinateur (CAO) à la réalisation des implants thoraciques sur mesure pour correction des pectus excavatum. Expérience du CHU de Nantes.

INTRODUCTION: Pectus excavatum is the most common congenital chest malformation and is a common reason for consultation in plastic surgery. Our attitude is most often a filling of the depression with a custom-made silicone prosthesis. The objective of this work was to evaluate the interest of computer-aided design (CAD) of implants compared to the conventional plaster molds method. PATIENTS AND METHODS: We have collected all the cases of custom-made silicone implants to treat funnel chests in our plastic surgery department. The quality of the results was evaluated by the patient, and in a blind manner by the surgical team using photographs and standardized surveys. The pre-operative delays, the operating time and length of hospital stays, the number of surgical recoveries, and the post-operative surgical outcomes were recorded. RESULTS: Between 1990 and 2016, we designed 29 silicone thoracic implants in our department. Before 2012, implants were made from plaster chest molds (n=13). After this date, implants were designed by CAD (n=16). Patients rated their results as "good" or "excellent" in 77% and 86% of cases respectively in the plaster and CAD groups. The surgical team's ratings for CAD implant reconstructions were better than in the plaster group: 8.17 versus 6.96 (P=0.001). CAD implants were significantly less detectable than the plaster group implants. The operating time was reduced in the CAO group: 60.2 compared to 74.7minutes in the plaster group (P=0.04), as was the length of hospitalization: 3.5 versus 5.3 days (P=0.01). There were no significant differences between the two groups in terms of post-operative complications. CONCLUSION: The management of pectus excavatum by a custom-made silicone implant is a minimally invasive method that provides good cosmetic results. The design of these implants is facilitated and qualitatively improved by CAD.

On the characterization of functionally graded biomaterial primed through a novel plaster mold casting process.

The current work presents a novel plaster mold casting (PMC) process for fabricating functionally graded biodegradable materials (FGBMs) for orthopedics applications. According to the proposed route, the plaster molds were first prepared by using a hybrid and variable mixture of Plaster of Paris (PoP) and hydroxyapatite (HAP). Upon drying, molten magnesium (Mg) alloy was poured in the mold cavity and allowed to solidify. Various experiments have been conducted as per Taguchi based design of experimentation to study the effect of PoPX/HAP proportion, mixing time, and baking times on mechanical, corrosion, and cytocompatibility performances of the resulting FGBM. It has been revealed by the scanning electron microscopy (SEM) that uniform layers of HAP particles were developed on the prepared specimens, revealed the novelty of the route. The mechanical properties, in case of surface hardness and impact strength, the optimum results were obtained with PoP(x = 90% by wt.) and HAP(y = 10% by wt.). Further, the corrosion investigations highlighted that the sample prepared with PoP(x = 70% by wt.) and HAP(y = 30% by wt.) proportion possessed excellent corrosion resistance. Moreover, the cytocompatibility analysis revealed that all the developed FGBM are substantially bioactive and promoted cell adhesion, proliferation, differentiation, and various other cytoplasmic activities. However, in this case, FGBM with PoP(x = 70% by wt.) and HAP(y = 30% by wt.) proportion was found superior. The overall results of the present work supported the developed FGBM components and involved the PMC route as a potential candidate for various orthopedics fabrications.