Buffalo, N.Y. (WBEN) - It was a month ago on Monday when Cheektowaga Police Officer Troy Blackchief was severely injured when he was struck by a suspect driving a stolen vehicle in Cheektowaga.
It was around 4:30 a.m. EST on Feb. 6 when Officer Blackchief was deploying stop sticks on Union Road at Route 33 in an attempt to end a pursuit related to stolen vehicles in the Village of Depew.
After being transported to Erie County Medical Center with a number of serious injuries, Blackchief required immediate surgery after suffering a skull fracture and brain injury. Cheektowaga Police Chief Brian Gould said two weeks ago that Officer Blackchief is still facing a "long and difficult" recovery.
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In a letter released by Cheektowaga Police this past Wednesday, Blackchief's family released another update on Troy's condition, saying he will be heading to Shirley Ryan AbilityLab in Chicago to begin the rehab process that is expected to last, at least, four weeks. In, at least, nine weeks, Blackchief will return to ECMC, as he will receive a cranioplasty that will see him get a new skull bone 3D printed and surgically placed in his head.
While the process of 3D printing a piece of a human skull is relatively new, it's becoming more prevalent to help not only with cosmesis, but also serve as a suitable replacement for pieces of the human skull that can be protective and patient-specific.
"When we initially do it craniectomy, we remove a significant amount of bone from the skull to allow the brain to swell. So when the brain is injured from a trauma or a stroke, it will swell. If you keep it in a closed box, like the skull, the swelling can actually damage healthy normal brain. So you need to give it room to swell out a little bit, so you remove this bone," said Dr. Elad Levy from the UB Jacobs School of Medicine. "When the brain heals and the swelling goes down, then it's safe to replace the bone, or in this case, 3D print a synthetic piece that's a mirror image of the other side."
In terms of getting the right patient-specific kind of implant, the first part of the process is getting some sort of 3D imaging of the skull - a CAT scan or an MRI scan - where the radiologist or a neuro radiologist looks at the skull or the part that needs to be operated on.
"They take the geometry, and then pass it through some sort of, let's call it a CAD or Computer Aided Design," said Dr. Ciprian Ionita from the UB Jacobs School of Medicine. "It's almost like you do for an architect that does a design for a building. This particular process, you take the geometry of the patient and you develop the part that you're going to replace it, design it, and then you pass it through a 3D printer that will make it exactly to fit the patient's geometry once it's done."
Historically, doctors have been able to remove a patient's own bone and then place it in the freezer, and then after several months, put it back in. However, that bone over time, or part of that bone may shrink or potentially become a source of infection. That's why the alternative has now become the 3D printing process that can creates a symetrical image of that missing piece.
To this point, with the help of computer 3D printing technologies, the procedure has been seen as extremely effective. For Dr. Ionita, he says he's been working with various investigators from different universities across the country to create a workflow and a standard for more of these 3D implants to be used in more hospitals.
"As of now - for example, for surgery - you have board-certified physicians that do the surgery. For treatment planning and cancer, you have board-certified medical physicists that do the planning for the radiation therapy machines. For the 3D printing we're just starting right now, we still need to make the standards and the way that it has to be regulated in order to make these implants to be put in patient," Dr. Ionita said. "So far, 3D printing is being used successfully for treatment planning, like for cardiac applications or for tumor removal. Mayo Clinic is using a lot this technology, but for implants, we're just starting."
As for the materials used for the 3D print implant, those materials are starting to change with the advancement of technology.
"The materials tend to be these synthetics that sort of feel like a resin or a plastic. They're often porous to allow your normal bone, the upper bone of the skull, to grow in and basically incorporate this synthetic bone replacement flap," said Dr. Levy.
In the United States, there's still not one product for the 3D printed material that is FDA fully-approved. However, in some countries in Europe, as well as South Korea, they are using a lot of titanium-based implants more often.
"It's based on a laser sintering approach, where you have the printer laying a layer of powder of the metal, and then they go with the laser and melt it," Dr. Ionita explained. "They create one layer at a time until the entire piece is created. I suspect it's going to be titanium. That's what I've seen the most being used in patient-specific implants."
To make sure this procedure is safe and clean from start-to-finish, Dr. Levy explains how it's done under ultra-sterile conditions.
"Often we get two pieces in case we're not comfortable with one or something happens to one. So when we print, typically we'll print two," he said. "Their sterile field are brought into the operating room, re-opened under sterile conditions onto the operating field only at the time of surgery, right before we're about to implant the 3D printed bone."
"We need to make sure that these procedures are clean and safe for the patients, especially in the type of the materials that are being used," Dr. Ionita added. "I think for titanium, it's pretty clear that we have used this kind of material for a long time, it has been used for implants. Other materials that different 3D printer manufacturers are provided, we still need to figure it out. That's why the FDA has not approved it yet, but for humanitarian use, there are cases where this kind of technology is used."
Once the procedure has been completed, usually the patient will stay in the hospital for 1-2 days to make sure there's no bleeding on the brain or bleeding between the brain and the synthetic piece.
"Then we also want to make sure that the scalp, which has now been opened, again, heals well and that the incisions are healing well and there's no infection in the incision," said Dr. Levy. "Of course, these do occasionally get infected, but in general, it's a very safe procedure."
As for the long-term outlook for the patient, doctors believe they have a greater possibility of being able to get back to activities of daily living.
'Certainly no contact sports, no significant labor, because even though the synthetic piece fits back into the defect, it certainly will never be the same or have the same integrity as your original skull," Dr. Levy said.
And with the advancement of the customization part of the procedure, Dr. Ionita feels it will actually help with making the surgery more optimal.
"There are probably going to be less complications, less rejections, less discomfort for the patients, because the part is made to fit that person, and that person only," he said. "We've seen all the time problems with the fact that the equipment or the devices that we're using, they're coming from a manufacturer and you are just given a set of discrete sizes that you can use for the patients. What happens when it's in-between? You make your best estimation that the next smallest or the next largest device is going to fit this patient, and it's not always quite right. So I think with customization by 3D printing and bringing in this biomedical engineering technology into the hospital, it's the way to go in the future."