We at SALSA have long embraced the benefits of inter-connectivity and Open Source solutions; surgical planning and collaboration are no exception. The concept of 3D surgical “printing” (templating and simulation) in lower extremity reconstruction is not entirely commonplace. This is likely for a number of reasons. With the continual maturation of free and Open Source software applications as well as the ever increasing capabilities of Reprap technology, these limitations are overcome.
Charcot foot reconstruction is a challenging endeavor with significant intraoperative demands and uncertainties. Even experienced surgeons benefit from preoperative preparation in order to reduce operative time and potential complications. Classic 2D templating techniques may fall short when faced with the multiplane and complex nature of neuroarthropathic architecture. For this, a scenario to improve surgical delivery was Co-designed by members of Dekalb Medical Residency, Southern Arizona Limb Salvage Alliance researchers, and Freeside Atlanta and then performed by Dr. S. Patrick Dunn DPM.
Clinical and Radiograph films of patient’s foot.
Computed Tomography demonstrating significant architectural destruction and luxation
Simulated osteotomies matched up to realworld osteotomies. Booleon simulation may be performed in a variety of freeware or profession 3D applications.
Before these models could be printed, the geometry and surface information needed to be further optimized. Our member, Patch, performed this in Meshlab, in order to optimize the geometry prior to ZPrint importation. These printed models were to attempt “freehand” osteotomies, matching the measured landmarks from the simulated ones, which were used to size and fit an Ilizarov frame construct. This construct was subsequently sterilized and used for the procedure itself, to follow.
-Nicholas Giovinco and David G. Armstrong