Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report
Abstract Background Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilizatio...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | 3D Printing in Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41205-022-00166-4 |
| _version_ | 1827985146728415232 |
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| author | Sarah C. Nyirjesy Ryan T. Judd Yazen Alfayez Peter Lancione Brian Swendseid Natalia von Windheim Stephen Nogan Nolan B. Seim Kyle K. VanKoevering |
| author_facet | Sarah C. Nyirjesy Ryan T. Judd Yazen Alfayez Peter Lancione Brian Swendseid Natalia von Windheim Stephen Nogan Nolan B. Seim Kyle K. VanKoevering |
| author_sort | Sarah C. Nyirjesy |
| collection | DOAJ |
| description | Abstract Background Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. Case presentation A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. Conclusions Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism. |
| first_indexed | 2024-04-09T23:10:13Z |
| format | Article |
| id | doaj.art-e094a1087e7841b6b988dce49709d9c5 |
| institution | Directory Open Access Journal |
| issn | 2365-6271 |
| language | English |
| last_indexed | 2024-04-09T23:10:13Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | 3D Printing in Medicine |
| spelling | doaj.art-e094a1087e7841b6b988dce49709d9c52023-03-22T10:27:43ZengBMC3D Printing in Medicine2365-62712023-02-01911910.1186/s41205-022-00166-4Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case reportSarah C. Nyirjesy0Ryan T. Judd1Yazen Alfayez2Peter Lancione3Brian Swendseid4Natalia von Windheim5Stephen Nogan6Nolan B. Seim7Kyle K. VanKoevering8Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterDepartment of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical CenterAbstract Background Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. Case presentation A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. Conclusions Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism.https://doi.org/10.1186/s41205-022-00166-4Three-dimensional printing (3D)Negative pressure wound therapyWound VacComputer assisted designNecrotizing fasciitisCase report |
| spellingShingle | Sarah C. Nyirjesy Ryan T. Judd Yazen Alfayez Peter Lancione Brian Swendseid Natalia von Windheim Stephen Nogan Nolan B. Seim Kyle K. VanKoevering Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report 3D Printing in Medicine Three-dimensional printing (3D) Negative pressure wound therapy Wound Vac Computer assisted design Necrotizing fasciitis Case report |
| title | Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report |
| title_full | Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report |
| title_fullStr | Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report |
| title_full_unstemmed | Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report |
| title_short | Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report |
| title_sort | use of 3 dimensional printing at the point of care to manage a complex wound in hemifacial necrotizing fasciitis a case report |
| topic | Three-dimensional printing (3D) Negative pressure wound therapy Wound Vac Computer assisted design Necrotizing fasciitis Case report |
| url | https://doi.org/10.1186/s41205-022-00166-4 |
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