Cardiff Met Researchers use design to rebuild a face

​15/03/2014

Guides were used to cut bones before realigning
them to remodel the face

​A motorcyclist who was severely injured in an accident has undergone pioneering surgery using techniques created by the Surgical & Prosthetic Design team at PDR (The National Centre for Product Design and Development Research) at Cardiff Metropolitan University.

The 29-year-old patient, Mr Stephen Power, was motorcycling with friends, when he was involved in an accident in Llantwit Major, near Cardiff in 2012 He broke both arms and his right leg was so badly damaged that it required a bone graft. He also suffered major injuries to his head and face and underwent emergency surgery at Morriston Hospital, Swansea.

He was treated by Abertawe Bro Morgannwg University Health Board orthopaedic and plastic surgeons. Consultant maxillofacial surgeon Adrian Sugar said: "We were able to do a pretty good job with all his facial injuries, with the exception of his left cheek and eye socket.

"We fixed his facial fractures pretty well but he had damaged his left eye and the ophthalmologists did not want us to do anything that might damage his sight further. That was a good move because his eyesight has mostly recovered. But as a result we did not get his left cheekbone in the right place and we did not even try to reconstruct the very thin bones around his eye socket. The result was that his cheekbone was too far out and his eye was sunk in and dropped."

The purpose of the most recent surgery was primarily to correct Stephen's appearance by precisely cutting and moving facial bones. This represented a significant challenge due to the complexity of the necessary movements and proximity of the operation to critical, sensitive anatomy. In order to offer the optimum outcome, a multidisciplinary approach using PDR's latest surgical planning, computer aided design and 3D printing techniques, was required.

PDR's Surgical & Prosthetic Design team are experts at working with hospitals across the UK to pioneer new ways of using advanced computer aided technologies to improve the predictability, efficiency and accuracy of surgical and prosthetic procedures (at lower overall treatment costs). PDR has a formal collaboration with the Maxillofacial Unit at Morriston Hospital; the Centre for Applied Reconstructive Technologies in Surgery (http://www.cartis.org/), which also involves the collaborative expertise of other local, national and international units.

Sean Peel, Design & Research Engineer from PDR, assisted the Morriston team in transforming the medical scan data of the patient into a virtual, 3D surgical model.

Precise locations for cuts that would free up sections of facial bone for movement were then agreed, working in close collaboration with the clinicians.

In order to translate these cuts into theatre, a custom fitting saw guide was designed to fit securely around the anatomy, with slots positioned to guide the surgeon's movement. Once the bone sections were freed in the virtual plan, they were carefully positioned to reconstruct the anatomy and provide the best possible symmetry.

Custom implants and a repositioning guide that would enable the bone sections to be held securely whilst the implants were placed were then designed.

Sean's PhD research focusses on improving the delivery of patient specific implants, used to reconstruct bony defects following trauma or disease. He said: "3D Printing is often promoted in surgical use for its own sake – with an emphasis on the technological capabilities of the machines. However, this case like hundreds of others undertaken by PDR shows that developing and using a robust design process is just as important.

"The interdisciplinary team works in two different technical languages using two contrasting skill sets from very divergent backgrounds. Through the CARTIS collaboration, PDR's design engineers are in a unique position to bridge this gap, translate, and find a balance between what is possible in the operating theatre and what is possible for design and fabrication."

3D printing was the most logical choice for producing the complex guides and implant shapes. PDR commissioned the manufacturing of cutting and positioning guides in bio-compatible cobalt chromium alloy to Renishaw, the only UK manufacturer of a metal 3D printing machine, which is increasingly applying its technology to medical applications. The implants were 3D printed in titanium by another Belgium-based supplier.

Mr Sugar led a multidisciplinary team that included ENT surgeon, Serryth Colbert, registrar, Ali Al-Rikabi, further theatre staff and prosthetists Peter Evans and Lawrence Dovgalski. The eight hour operation went extremely smoothly, with the guides and implants fitting according to plan. Recovery has gone well since the operation and the swelling is gradually going down, revealing the final outcome.

PDR Unit Manager, Dr. Dominic Eggbeer said: "The successful outcome is testament to the virtues of involving a multidisciplinary team that included University, NHS and industry partners. PDR's skilled team includes Design & Research Engineer, Sean Peel, Research Associate, Ffion O'Malley and Technician, Emily Bilbie, who are routinely embedded in hospital departments to learn first-hand about the real-world requirements of clinicians.

We use design knowledge to provide the crucial link between surgical techniques and state of the art engineering technologies."

The team's next challenge is to refine the planning, design and manufacturing process to make these techniques as efficient as possible. This is crucial to ensure much wider healthcare service benefits.

Mr Power's operation is currently being featured in an exhibition at the Science Museum in London, called 3D Printing: The Future.