Moreau P1, Herfat S1,2
1Médecins Sans Frontières Foundation, Paris, France, 2University of California San Francisco, San Francisco, United States
Background: Médecins Sans Frontières / Doctors Without Borders (MSF) is providing burn care in several of its missions, including in Haiti and the Middle East. Conflicts and low resources settings lead to challenging urban living conditions for populations. Dangers associated with improper use of electrical devices, gas settings and overcrowded housing increase the risk of burn cases from explosion, electricity, boiling liquids and cooking fires. Deep facial burns require long and specialized treatments with esthetic and functional complications. Among face burn care standards, application of the TFO is required to limit the appearances of scar complications.
Purpose: TFOs are not always available to patients in humanitarian settings due to lack of access to specific materials and trained rehabilitation professionals with special training to fabricate these orthoses. TFOs customized for each patient are made through a complex process requiring a plaster print of the face which is uncomfortable for the patient, especially with children. MSF Foundation aims to develop a scalable process that could increase access to these devices in challenging places.
Methods: A 3D surface scan of the patient face is first acquired. The surface scan model is then processed on a CAD/CAM software to design the TFO through digital rectification to modify pressures on the facial structure. This step can be performed remotely by a trained expert. Then a negative of the modified face is 3D printed in Polyactic acid (PLA) allowing the local team to prepare the mask using plaster and high temperature thermoplastic (PETG). During the summer 2018, Three preliminary cases benefited from the 3D scanning technology and digitalized modifications in the MSF Reconstructive Surgery Hospital in Amman, Jordan.
Results: This proof of concept was only based on the feasibility of the process. The first patient benefited from the assisted 3D technologies implemented by local professional staff. For the two other cases, digital modifications were performed remotely by an expert. For all three cases, the local MSF rehabilitation team and the patients did not report any clinical dissatisfaction with this process. The final TFO were able to be worn by the patient as they were the same PETG material as the conventional TFO.
Conclusion(s): This pilot project showed the feasibility of realizing a Burn TFO by implementing 3D technologies with remote rectification. A full study is necessary to demonstrate the efficiency of this process and is currently being designed.
Implications: The use of this method could increase access to specific facial burn care in challenging places where there are currently no solutions available. Furthermore, the use of 3D technologies, especially the 3D surface scan, can simplify the conventional process and provide more comfort to the patient.
Keywords: Facial burn, transparent facial orthosis, 3D printing
Funding acknowledgements: This Project was funded by MSF Foundation donors.
Purpose: TFOs are not always available to patients in humanitarian settings due to lack of access to specific materials and trained rehabilitation professionals with special training to fabricate these orthoses. TFOs customized for each patient are made through a complex process requiring a plaster print of the face which is uncomfortable for the patient, especially with children. MSF Foundation aims to develop a scalable process that could increase access to these devices in challenging places.
Methods: A 3D surface scan of the patient face is first acquired. The surface scan model is then processed on a CAD/CAM software to design the TFO through digital rectification to modify pressures on the facial structure. This step can be performed remotely by a trained expert. Then a negative of the modified face is 3D printed in Polyactic acid (PLA) allowing the local team to prepare the mask using plaster and high temperature thermoplastic (PETG). During the summer 2018, Three preliminary cases benefited from the 3D scanning technology and digitalized modifications in the MSF Reconstructive Surgery Hospital in Amman, Jordan.
Results: This proof of concept was only based on the feasibility of the process. The first patient benefited from the assisted 3D technologies implemented by local professional staff. For the two other cases, digital modifications were performed remotely by an expert. For all three cases, the local MSF rehabilitation team and the patients did not report any clinical dissatisfaction with this process. The final TFO were able to be worn by the patient as they were the same PETG material as the conventional TFO.
Conclusion(s): This pilot project showed the feasibility of realizing a Burn TFO by implementing 3D technologies with remote rectification. A full study is necessary to demonstrate the efficiency of this process and is currently being designed.
Implications: The use of this method could increase access to specific facial burn care in challenging places where there are currently no solutions available. Furthermore, the use of 3D technologies, especially the 3D surface scan, can simplify the conventional process and provide more comfort to the patient.
Keywords: Facial burn, transparent facial orthosis, 3D printing
Funding acknowledgements: This Project was funded by MSF Foundation donors.
Topic: Disability & rehabilitation; Disaster management
Ethics approval required: No
Institution: Médecins Sans Frontières
Ethics committee: MSF Ethic committee
Reason not required: This research fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) and thus did not require MSF ERB review. This project aims to describe new innovative way to design transparent facial orthosis for facial burned patient in humanitarian context.
All authors, affiliations and abstracts have been published as submitted.
