Monday, May 11, 2015
A mix of new technology and old style mask-making is changing the way surgeons operate on young patients with rare skin disorders.
Two-year-old Lily Hall of Kentucky was born with nevus sebaceous syndrome leaving large pigmented birthmarks on her face, head and neck. It happens in about 1 in 10,000 children who are born. The syndrome carries a significant risk for developing basal cell carcinoma and squamous cell carcinoma- both dangerous forms of skin cancer- as children get older.
“For us, it was never really an option NOT to do anything,” said Brandi Hall, Lily’s mother. “My husband and I knew we were going to get it removed as soon as we possibly could.”
Since the birthmarks are spread throughout her body, Lily faces numerous complex surgeries. Before going into the operating room, new skin must first be generated by using tissue expanders.
“Tissue expanders are like water balloons,” said Thomas Sitzman, MD, a plastic surgeon in the Pigmented Lesion Clinic at Cincinnati Children’s. “The deflated expanders are placed under the skin near the birthmark. Lily’s parents slowly fill the expanders at home over a period of three months. As the expanders inflate, they stretch the normal skin nearby. We then use that normal skin to remove the birthmark.”
To reduce the number of future surgeries, Dr. Sitzman collaborated with Matt Batie to create a unique 3D printed model for each child. Batie works in the department of clinical engineering at Cincinnati Children’s.
“"After we scan the patient I digitally add the expanders to the model and prepare the file to print,” said Batie. “Then in a matter of hours we have a life size replica of the patient."
Batie then makes synthetic skin similar to a Halloween mask in his lab using a custom formula. The skin is placed over the 3D model allowing Dr. Sitzman to simulate different surgical approaches for each patient. Using the models to refine the surgical approach, Dr. Sitzman is able to determine the best approach for each patient before going into the operating room.
“You only get one shot with how you are going to do this surgery. Being able to model each individual patient’s surgery in advance is a tremendous step forward in how we care for patients,” said Dr. Sitzman.