Abstract Autologous ear reconstruction is the preferred treatment in case of partial or total absence of the patient external ear. This kind of surgery can be really challenging since precise replication of complex three-dimensional structure of the ear is crucial to provide the patients with aesthetically consistent reconstructed anatomy. Therefore, the results strongly depends on the “artistic skills” of the surgeon who is in charge to carry out a three-dimensional sculpture, which resembles the shape of a normal ear. In this context, the definition of a preoperative planning and simulation process based on the patient's specific anatomy may help the surgeon in speeding up the ear reconstruction process and, at the same time, to obtain better results, thus allowing a superior surgical outcome. In the present work the main required features for performing an effective simulation of the ear reconstruction are identified and a strategy for their interactive design and customization is devised with the perspective of a semi-automatization of the procedure. In detail, the paper provides a framework which start from the acquisition of 3D data from both a healthy ear of the patient (or, if not available e.g. due to bilateral microtia of the ear of one of his parents or from a template) and of costal cartilage. Acquired 3D data are properly processed to define the anatomical elements of the ear and to find, using nesting-based algorithms, the costal cartilage portions to be used for carving the ear itself. Finally, 3D printing is used to create a mockup of the ear elements and a prototype of the ear to be reconstructed is created. Validated on a test case, the devised procedure demonstrate its effectiveness.
Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake positively affecting cardiac output. In subjects with pectus excavatum cardiac output increase during exercise might be limited by the conformation of the chest. In this condition, the psychological impact of the deformity can further reduce the propensity to physical activity, leading to a sedentary lifestyle. Surgery is the preferred choice in severe cases. However, many patients with milder deformities can benefit from exercise-based treatment. The choice of the therapeutic strategy is fundamental, but the functional parameters on which to base this choice are not yet well defined. Therefore, we investigated the relationships between habitual physical activity and functional physiological parameters obtained from the cardiopulmonary exercise test (exercise performance and stroke volume at peak exercise) in pectus excavatum.A cohort of adolescents (15 with pectus excavatum and 15 age- and sex-matched healthy controls) underwent Cardiopulmonary Exercise Test to estimate exercise performance (VO2 max) and stroke volume at peak exercise (VO2/HR, O2 pulse). Habitual weekly physical activity, estimated with International Physical Activity Questionnaire - Short Form (IPAQ-SF), was expressed as METs h-1·week-1. Determinants of exercise performance and stroke volume at peak exercise were investigated in the whole group with multivariable linear regression analysis adjusted for sex, body mass index, forced expiratory volume in the first second, and presence of pectus excavatum.When compared to healthy controls, subjects with pectus excavatum had lower VO2 max (37.2 ± 6.6 vs 45.4 ± 6.4 mL·kg-1·min-1, p < 0.05), and O2 pulse (12.1 ± 2.4 vs 16.2 ± 3.6 mL·min-1·bpm-1, p < 0.05). Importantly, physical activity level was a predictor of VO2 max (B = 0.085; 95% Cl 0.010 to 0.160) while it did not affect O2 pulse (B = 0.035; 95% Cl -0.004 to 0.074).Training programs should be encouraged to increase cardiopulmonary performance in subjects with pectus excavatum. A marked reduction in O2 pulse at peak exercise might be considered as a criteria to address a subject towards surgery.
In the past decade, the minimally invasive repair of pectus excavatum (MIRPE) has become the treatment of choice for severe pectus excavatum (PE), proving acceptable to excellent cosmetic results. Recently, autologous fat grafting (FG) has been identified in aesthetic and reconstructive surgery to ideally handle volume and contour defects. We report our experience about FG in the treatment of residual minor defects after MIRPE and a proposal for a new indication of this largely adopted technique.From April 2012 to April 2015, 127 patients underwent bar removal. At outpatient check, a questionnaire was adopted to investigate aesthetic outcome prior and after surgery (3 months postoperation); scoring options varied from 4 to 0 [4, excellent; 3, very good; 2, good; 1, acceptable; and 0, unacceptable]. In patients scoring less than "good," we proposed FG at the same operating session of bar removal. The donor areas were the abdomen, trochanteric region, and inner thigh. The tissue was gently collected through a thin cannula, filtrated, and then promptly injected into the defect.Eleven patients (8.8%) have been selected for FG. No complications have been detected during the follow-up period (range 1-36 months). In three cases, we performed further FG procedure to achieve an optimal result. Questionnaire reported an increased mean score from 1.8 to 2.7.In our early experience, FG has provided satisfactory cosmetic results. With the present report we advocate FG as a minimally invasive "tool" to achieve better defect correction after MIRPE. These preliminary results suggest that FG could be a worthwhile resource in treating chest wall malformations.
This paper describes a sensorized orthosis used to objectively monitor the follow-up of pediatric patients affected by Pectus Carinatum and treated through compression therapy. The study reports an analysis made on 25 patients. The pressure exerted by the compression brace was monitored by means of a high-density sensing matrix at every outpatient check, over 150 days. The pressure maps derived from this analysis correlated with the clinical parameters indicating a successful outcome for the treatment of specific deformity types such as symmetric chondrogladiolous and rib flares. Results demonstrate that bracing is an effective tool in well-motivated patients in the previously mentioned deformity types. Pressure mapping emerged as a parameter to objectively assess treatment efficacy and may pave the way to a new generation of orthoses with high-density sensorized elements chronically embedded in their structure.
Disruptive 3D technologies, such as reverse engineering (RE) and additive manufacturing (AM), when applied in the medical field enable the development of new methods for personalized and non-invasive treatments. When referring to the monitoring of pectus excavatum, one of the most common thoracic malformations, 3D acquisition of the patient chest proved to be a straightforward method for assessing and measuring chest deformation. Unfortunately, such systems are usually available in a dedicated facility, can be operated only by specialized doctors with the support of engineers and can be used only with patients on site. It is therefore impossible to perform any routine check-up when the patient is unable to reach the outpatient clinic. The COVID19 pandemic situation has placed even greater restrictions on patient mobility, worsening this problem. To deal with this issue, a new low-cost portable optical scanner for monitoring pectus excavatum is proposed in this work. The scanner, named Thor 2.0, allows a remote diagnostic approach, offering the possibility to perform routine check-ups telematically. Usability tests confirmed the user-friendly nature of the devised system. The instrument was used at the Meyer Children’s Hospital (Florence, Italy) chest-malformations center to treat PE patients. The performed measurements proved to be in line with the current state of the art.
