MÃ©decins Sans FrontiÃ¨res (MSF), also known in English as Doctors Without Borders, does some of the most important work to help suffering people around the world. MSF has turned to 3D printing and related technologies in its work in constructing hospitals, as well as in more patient-centric applications. For more than a decade, the organization has operated a reconstructive surgery hospital in Amman, Jordan where victims of bomb blasts, bullets and other war-related wounds are healed.
“When we initially opened this hospital, nobody thought we were going to stay 10 years,” said Marc Schakal, MSF head of mission for the reconstructive surgery program. “But after 4,500 admissions and more than 11,000 surgical interventions, it's clear we have work for the next 10 years, and one hospital is not enough.”
The surgical team is made up of four orthopaedic surgeons, one maxillofacial surgeon, and one plastic surgeon, all from Jordan or Iraq. The hospital was initially opened to treat war-wounded Iraqis without access to health care, but as violence spread across the region, it began admitting patients from Syria, Yemen, Palestine, and Libya. Those countries in particular were suffering from a lack of medical staff, poverty, and the destruction of health infrastructure.
Many of the patients who arrive at the hospital are missing limbs, and at the beginning of this year, the MSF Foundation reached out to the hospital’s reconstructive surgery program with a new project whose goal was to design and 3D print prosthetics for patients missing partial or entire upper limbs. The hospital had plenty of options for lower-limb amputees, but not so many for people who had lost upper limbs, so the project was a welcome one.
The MSF Foundation initiated the program in 2016, and is now working with patients to demonstrate that 3D printed prosthetics are not only effective, but faster and cheaper to produce than their traditionally manufactured counterparts. Currently, the project team is working with five patient-volunteers who have been fitted with what are known as cosmetic, passive, definitive prostheses. Eventually they will work with active prostheses, which will enable them to handle tasks such as cooking, driving or using tools.
The patient-volunteers include both adults and children, who give detailed feedback on what their needs are and how the prosthetics fit and feel. A six-step process is used to fit a patient for a prosthetic limb. The patient first undergoes a detailed clinical assessment to determine what his or her needs are, then a 3D scan is taken of the stump of the patient’s arm to ensure a proper fit. A socket and prosthesis are modeled using 3D software, then the device is 3D printed, often using a desktop Ultimaker 3D printer. Tests are done to verify the adjustment to the prosthesis and assess any needed modifications. A full evaluation is then carried out after three months of use.
According to the hospital in Amman, the project is still a work in progress, but people are being helped – it can be a tremendous boost to a patient’s mental well-being to have cosmetic prosthetic matching one’s dimensions and skin tone, rather than nothing. There are around 40 million amputees in the world, and right now only about five percent of them have access to prosthetic care. Every time a program like this one arises, that percentage gets a tiny bit higher, and 3D printing makes it possible for more of these programs to exist more inexpensively.
The MSF team working on 3D technology advances to benefit amputees includes physiotherapist Pierre Moreau, biomedical engineer Safa Herfat and orthoprosthesist Hatim Masadeh. Work in 2017 has encompassed identifying their patient-volunteers, creating personalized protocol, scanning and 3D printing to compare traditionally-manufactured sockets and those 3D printed at Fablab Irbid, working to match patients’ skin tones with acrylic paint to finish 3D printed prosthetics, and beginning to identify and explore other potential areas of application for 3D printing in reconstructive surgery, including 3D printed masks for burn victims and 3D printed anatomical models for pre-surgical preparation and simulation.
In 2018, the team will be exploring solutions for field contexts. They explain:
“The ongoing research into 3D technology is promising, but more time and investment is required before these techniques can be deployed more widely and be of service to the different MSF field teams.”
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