METHOD, MATERIAL, AND MACHINE: THE 3MS OF IN-HOUSE 3D PRINTING FOR THE PLASTIC SURGEON
Helen Xun, BS1, Scott Clarke, BS2, Nusaiba Baker, PhD3, Erica Lee, BS, MS1, Christoper Shallal4, Leen El Eter, BS1, Gerald Brandacher, MD, FACS1, Sung Hoon Kang, PhD4, Justin Sacks, MD, MBA, FACS5.
1Johns Hopkins School of Medicine, Baltimore, MD, USA, 2Dalhousie University, Halifax, NS, Canada, 3Emory University School of Medicine, Atlanta, GA, USA, 4Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA, 5Washington University in St. Louis, St. Louis, MO, USA.
BACKGROUND: This study is a succinct resource for plastic surgeons selecting tabletop, plug and play 3D printers for accelerated device production, virtual surgical planning, surgical guides, or patient and resident education. The first 3D printer was released in 1987 by Chuck Hull; however, it was only until recent years that the advent of commercially available, affordable, 3D printers with user-friendly interfaces that in-house 3D printing has become a possibility for surgeons. In-house 3D printing is more cost-effective (20 times more expensive when outsourced to third-party vendors), and provides the surgeon investigator with more control over time and workflow. However, the greatest challenge is the initial engineering learning curve of 3D printers. Consequently, we present a starting guide to establishing a 3D printing lab for Plastic and Reconstructive Surgeons.
METHODS: Commercially available 3D printers in the USA were identified via web search; printers were excluded from the study if they had prohibitive costs (>$15,000), assembly requiring advanced technical skills, composition material, and lack of worldwide availability. Printer manufacturer spec sheets were reviewed, and pertinent information was extracted. Variables collected include extrusion type, filament diameter, build volume, printer size, weight, auto level, heated bed, extruder temperature, layer resolution, dual extrusion capability, light source, slicing software, and price. A literature review was conducted to identify properties of biocompatible materials suitable for printing.
RESULTS: We identified 309 total commercially available printers, and excluded 98 due to cost, 41 due to requirement for assembly, 39 due to composition material, and 13 due to lack of worldwide availability. Our final review includes 118 printers for plastic and reconstructive surgeon investigators desiring affordable, plug-and-play printers. We report parameters for each machine and common biocompatible materials to facilitate the selection of appropriate methodologies. We developed an algorithm to help plastic surgeons select for method, material, and machine (Figure 1). We have used findings from this study to make recommendations to plastic and reconstructive surgeons and residents across multiple institutions on appropriate machines for their project goals.
CONCLUSIONS: In this study, we develop an algorithm that allows plastic surgeons without engineering backgrounds to easily select a 3D printer based on method, material, and machine parameters. We review the basic concepts of 3D printing and easy step-by-step. Plastic and reconstructive surgeons would benefit from this review due to the highly innovative culture, and the large volume of 3D printed surgical planning tools and devices produced yearly. 
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