Skin and Bones Repaired by Bioprinting

Fixing traumatic injuries to the skin and bones of the face and skull is difficult because of the many layers of different types of tissues involved, but now, researchers have repaired such defects in a rat model using bioprinting during surgery, and their work may lead to faster and better methods of healing skin and bones.

Schematic of the skin and bone bioprinting process. After scanning, the bone and then skin layers are bioprinted creating a layered repair with bone, a barrier layer, and dermis and epidermis

This work is clinically significant,” said Ibrahim T. Ozbolat, Associate Professor of Biomedical Engineering and Neurosurgery, Penn State. “Dealing with composite defects, fixing hard and soft tissues at once, is difficult. And for the craniofacial area, the results have to be esthetically pleasing.

Currently, fixing a hole in the skull involving both bone and soft tissue requires  using bone from another part of the patient’s body or a cadaver. The bone must be covered by soft tissue with blood flow, also harvested from somewhere else, or the bone will die. Then surgeons need to repair the soft tissue and skin. Ozbolat and his team used extrusion bioprinting and droplet bioprinting of mixtures of cells and carrier materials to print both bone and soft tissueThere is no surgical method for repairing soft and hard tissue at once,” said Ozbolat. “This is why we aimed to demonstrate a technology where we can reconstruct the whole defect — bone to epidermis — at once.”

The researchers attacked the problem of bone replacement first, beginning in the laboratory and moving to an animal model. They needed something that was printable and nontoxic and could repair a 5-millimeter hole in the skull. The “hard tissue ink” consisted of collagen, chitosan, nano-hydroxyapatite and other compounds and mesenchymal stem cells — multipotent cells found in bone marrow that create bone, cartilage and bone marrow fat. The hard tissue ink extrudes at room temperature but heats up to body temperature when applied. This creates physical cross-linkage of the collagen and other portions of the ink without any chemical changes or the necessity of a crosslinker additive.

The researchers used droplet printing to create the soft tissue with thinner layers than the bone. They used collagen and fibrinogen in alternating layers with crosslinking and growth enhancing compounds. Each layer of skin including the epidermis and dermis differs, so the bioprinted soft tissue layers differed in composition. Experiments repairing 6 mm holes in full thickness skin proved successful. Once the team understood skin and bone separately, they moved on to repairing both during the same surgical procedure. “This approach was an extremely challenging process and we actually spent a lot of time finding the right material for bone, skin and the right bioprinting techniques,” said Ozbolat.

The scientists have reported their results in Advanced Functional Materials.

Source: https://news.psu.edu/

3D printing becoming a surgical game changer

Imagine 1,000 puzzle pieces without any picture of what it’s ultimately supposed to look like. With few, if any, reference points, the challenge of fitting them together would be daunting. That’s what surgeons often confront when a patient suffering from a traumatic injury or condition has a portion of their body that is dramatically damaged or changed. The “puzzle” can be exponentially harder when the injuries involve a person’s face or skull – areas of the human anatomy that are complex, difficult to surgically navigate, and often require both functional and near-perfect cosmetic repair.

Now, thanks to high-tech equipment that is sometimes not much bigger than a home printer, UC Davis Health physicians are enhancing their capabilities and mapping out surgeries in ways that benefit patients and surgical outcomes.

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3D printing, which for us means manufacturing that’s accurate, affordable and on-site, can be a game changer in health care,” said David Lubarsky, vice chancellor for Human Health Sciences and CEO of UC Davis Health, who is very encouraged by the university’s newest technology initiatives and promising results.

The new device is a specialized but fairly affordable printer that produces three-dimensional models of an individual’s skull or body part. The 3D models enable a surgeon to visualize, practice and then perform the reconstructive surgery while saving time and increasing precision.

Facial reconstructive surgery involves intricate anatomy within an extremely narrow operative field in which to maneuver our instruments,” said E. Bradley Strong, a professor of otolaryngology who specializes in facial reconstructive surgery. “Being able to print out a high-resolution 3D model of the injury, allows us to do detailed preoperative planning and preparation that is more efficient and accurate. We can also use these patient specific models in the operating room to improve the accuracy of implant placement.”

The 3D printer used by Strong and his colleagues for the past year is about the size of a mini-refrigerator and costs approximately $4,000. It uses the imaging data from a patient’s computed tomography (CT) scans to provide the modeling output information. Like an inkjet printer, the 3D version spits out layer upon layer of material over a period of hours, sometimes taking nearly a day to complete, depending on the complexity of the model. The finished replica can save time during surgery, which means less time on the operating table for a patient and potentially a better outcome.

By creating a 3D model prior to surgery, Strong is able to bend and customize generic surgical plates into patient-specific shapes that fit perfectly for each individual patient.

Source: https://health.ucdavis.edu/

Robots Help Surgeons To Do The Impossible

Robotic surgery and robotically-assisted surgery have become increasingly widespread in recent years. At the cutting edge of this technology is Eindhoven Medical Robotics, a Eindhoven University of Technology (TU/e) related start-up.

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Robotics pioneer Maarten Steinbuch, a mechanical engineer by training, is building Eindhoven Medical Robotics with a Jeff Bezos-like 20-year vision … as an enduring business that could redefine this global semiconductor center while revolutionizing the medical world. And he’s hiring with a goal of building EMR into a 1,000-employee company over the next 10 years … but more about that in a minute. At HighTechXL Beyond tech conference and demo day, Steinbuch was one of 10 presenters. His talk was titled “The Future of Medical Robotics,” but he touched on multiple topics including Moore’s Law, emerging technology that will make it illegal for humans to drive cars and the reality of the Robot Revolution. (A hint: The tech behind personal robots is way too expensive right now to be practical, and it’ll be 10 years before you have a robot in your home.) Which was all interesting until he started laying out his vision for building his business.

Steinbuch is a bit like Silicon Valley legend Jim Clark, who founded multiple landmark tech businesses including Netscape and Silicon Graphics. Developing the technology as a professor at Technical University of Eindhoven (TU/e), Steinbuch and his teams of researchers and engineers created Eindhoven’s first startup robotic surgery company back in 2010. TU/e’s Sofie robotic surgery technology competed with da Vinci Surgical Systems, a global phenomenon owned by a Silicon Valley firm, Intuitive Surgical.

He found out quickly that da Vinci “has all the patents” as well as a huge staff dedicated to specifically trying to thwart competitors, Steinbuch told the crowd.

His painful takeaway from that venture: “To do a medical robotics startup, the amount of money you need is beyond imagination if you’re a professor at a university,” at least 10 million to 20 million euros, Steinbuch said. To get back in the game, he had to first figure out which technology could become a viable business. Rather than taking on da Vinci directly, he came up with was a master-slave system that could assist surgeons in operating on the retina, filtering out surgeon’s hand tremors. There are only a few doctors who can suture lymph nodes, for example, at 3 millimetres, “and only in the morning,” Steinbuch said. “We make super surgeons – that’s what we do.”

Source: http://www.medicalrobotictechnologies.com/