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Article: A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively

TitleA review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively
Authors
Keywords3D printing
Infection
Sterilization
ABS
Issue Date2020
PublisherSpringerOpen. The Journal's web site is located at https://threedmedprint.springeropen.com/
Citation
3D Printing in Medicine, 2020, v. 6, p. article no. 7 How to Cite?
Abstract3D printing in the context of medical application can allow for visualization of patient-specific anatomy to facilitate surgical planning and execution. Intra-operative usage of models and guides allows for real time feedback but ensuring sterility is essential to prevent infection. The additive manufacturing process restricts options for sterilisation owing to temperature sensitivity of thermoplastics utilised for fabrication. Here, we review one of the largest single cohorts of 3D models and guides constructed from Acrylonitrile butadiene styrene (ABS) and utilized intra-operatively, following terminal sterilization with hydrogen peroxide plasma. We describe our work flow from initial software rendering to printing, sterilization, and on-table application with the objective of demonstrating that our process is safe and can be implemented elsewhere. Overall, 7% (8/114 patients) of patients developed a surgical site infection, which was not elevated in comparison to related studies utilizing traditional surgical methods. Prolonged operation time with an associated increase in surgical complexity was identified to be a risk factor for infection. Low temperature plasma-based sterilization depends upon sufficient permeation and contact with surfaces which are a particular challenge when our 3D-printouts contain diffusion-restricted luminal spaces as well as hollows. Application of printouts as guides for power tools may further expose these regions to sterile bodily tissues and result in generation of debris. With each printout being a bespoke medical device, it is important that the multidisciplinary team involved in production and application understand potential pitfalls to ensuring sterility as to minimize infection risk.
Persistent Identifierhttp://hdl.handle.net/10722/283229
ISSN
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorShea, GKH-
dc.contributor.authorWu, KLK-
dc.contributor.authorLi, IWS-
dc.contributor.authorLeung, MF-
dc.contributor.authorKo, ALP-
dc.contributor.authorTse, L-
dc.contributor.authorPang, SSY-
dc.contributor.authorKwan, KYH-
dc.contributor.authorWong, TM-
dc.contributor.authorLeung, FKL-
dc.contributor.authorFang, CX-
dc.date.accessioned2020-06-22T02:53:45Z-
dc.date.available2020-06-22T02:53:45Z-
dc.date.issued2020-
dc.identifier.citation3D Printing in Medicine, 2020, v. 6, p. article no. 7-
dc.identifier.issn2365-6271-
dc.identifier.urihttp://hdl.handle.net/10722/283229-
dc.description.abstract3D printing in the context of medical application can allow for visualization of patient-specific anatomy to facilitate surgical planning and execution. Intra-operative usage of models and guides allows for real time feedback but ensuring sterility is essential to prevent infection. The additive manufacturing process restricts options for sterilisation owing to temperature sensitivity of thermoplastics utilised for fabrication. Here, we review one of the largest single cohorts of 3D models and guides constructed from Acrylonitrile butadiene styrene (ABS) and utilized intra-operatively, following terminal sterilization with hydrogen peroxide plasma. We describe our work flow from initial software rendering to printing, sterilization, and on-table application with the objective of demonstrating that our process is safe and can be implemented elsewhere. Overall, 7% (8/114 patients) of patients developed a surgical site infection, which was not elevated in comparison to related studies utilizing traditional surgical methods. Prolonged operation time with an associated increase in surgical complexity was identified to be a risk factor for infection. Low temperature plasma-based sterilization depends upon sufficient permeation and contact with surfaces which are a particular challenge when our 3D-printouts contain diffusion-restricted luminal spaces as well as hollows. Application of printouts as guides for power tools may further expose these regions to sterile bodily tissues and result in generation of debris. With each printout being a bespoke medical device, it is important that the multidisciplinary team involved in production and application understand potential pitfalls to ensuring sterility as to minimize infection risk.-
dc.languageeng-
dc.publisherSpringerOpen. The Journal's web site is located at https://threedmedprint.springeropen.com/-
dc.relation.ispartof3D Printing in Medicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subject3D printing-
dc.subjectInfection-
dc.subjectSterilization-
dc.subjectABS-
dc.titleA review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively-
dc.typeArticle-
dc.identifier.emailShea, GKH: gkshea@hku.hk-
dc.identifier.emailWu, KLK: lwu03@hku.hk-
dc.identifier.emailLi, IWS: liws03@hku.hk-
dc.identifier.emailLeung, MF: manfai@hku.hk-
dc.identifier.emailKwan, KYH: kyhkwan@hku.hk-
dc.identifier.emailWong, TM: wongtm@hku.hk-
dc.identifier.emailLeung, FKL: klleunga@hkucc.hku.hk-
dc.identifier.emailFang, CX: cfang@hku.hk-
dc.identifier.authorityShea, GKH=rp01781-
dc.identifier.authorityKwan, KYH=rp02014-
dc.identifier.authorityWong, TM=rp01689-
dc.identifier.authorityLeung, FKL=rp00297-
dc.identifier.authorityFang, CX=rp02016-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/s41205-020-00061-w-
dc.identifier.pmid32232596-
dc.identifier.pmcidPMC7106677-
dc.identifier.hkuros310619-
dc.identifier.volume6-
dc.identifier.spagearticle no. 7-
dc.identifier.epagearticle no. 7-
dc.publisher.placeGermany-

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