3D Printing of a Patient-Specific Biomodel and Cutting Guide for Metatarsal Reconstruction With an Osteocutaneous SCIP Flap Using Open-Source Software: A Case Report.

Abstract

Technology-assisted planning is increasingly integrated into reconstructive plastic surgery, including virtual reality, augmented reality, and three-dimensional (3D) printing. 3D printing has been especially useful in maxillofacial surgery, both for patient-specific cutting guides for osteotomies and for biomodels to customize osteosynthesis plates. However, to our knowledge, there have been no reports of a 3D-printed cutting guide to harvest a custom iliac crest bone flap based on the deep branch of the superficial circumflex iliac artery perforator (SCIP) flap, together with a biomodel of the foot skeleton with the bone defect for intraoperative use. We report a 36-year-old man with a 45-mm bone defect of the first metatarsal and a 9 × 8 cm skin defect on the dorsum of the right foot after firearm trauma. Computer-aided design and computer-aided manufacturing (CAD/CAM) using open-source software were used to prepare a cutting guide that allowed harvesting a bone flap of precise dimensions and a biomodel that enabled intraoperative adjustment of the flap without pedicle division. Reconstruction was achieved with a 45-mm bone flap based on the deep branch of the SCIP and a 9 × 8 cm skin flap based on the superficial branch of the SCIP. Both flaps survived without complications; bone consolidation was observed at 4 months, and at 10 months, the patient had an adequate, pain-free gait. This case illustrates that an open-source, low-cost 3D-printing workflow may be a useful adjunct for planning and execution of metatarsal reconstruction with osteocutaneous free flaps.