A Perforator Model As an Aid to Elevate Deep Inferior Epigastric Perforator Flap.

Sir: Recently, personal three-dimensional (3D) printers have become available. These printers are easy to handle and affordable to buy. Three- dimensional mandibular models and auricular chondral framework 3D models built with a personal 3D printer by using free software have been reported.1,2 Three-dimension printed breast molds are also used in breast reconstruction.3 Three-dimensional vascular perforator anatomy printing allows improved visualization and manipulation of anatomical structures compared with two- dimensional representations.4 We produced a 3D perforator model to understand the anatomy of the deep inferior epigastric artery and to use as an aid to elevate the deep inferior epigastric perforator (DIEP) flap. Contrast-enhanced multidetector-row computed tomography studies were prospectively performed in patients before undergoing breast reconstruction surgery by a DIEP flap. The 3D models were made by using a personal 3D printer (MakerBot Replicator 2× Desktop 3D Printer, MakerBot Industries, Brooklyn, N.Y.; $2799) as we have reported previously2; digital imaging and communications in medicine data of axial computed tomographic images were transferred to InVesalius (Technology of Information Renato Archer Centre of the Ministry of Science and Technology in Campinas, Brazil), to convert into an .stl (stereolithography) file. Next, the .stl file was converted into 3D printer data by using MakerWare (MakerBot Industries, Brooklyn, N.Y.) software. The model was printed by Acrylonitrile Butadiene Styrene filament using the 3D printer’s dual extrusion technology with different-colored supports and rafts (Fig. 1). To introduce the printed model into the operation room and to use it as an aid to elevate DIEP flap, the 3D model was sterilized by a low-temperature sterilization (STERRAD, Advanced Sterilization Products, Division of Ethicon US, LLC, a Johnson & Johnson company, Irvine, Calif.; Fig. 2).Fig. 1: Making the model on the software. Dual extrusion of the filament is planned. The purge walls are created automatically by the software to give us the best quality for dual-extrusion prints.Fig. 2: Using the model as an aid to elevate DIEP flap. It is sterilized and placed onto the abdominal wall in the clean operative field. The deep epigastric artery was printed by a red filament, whereas the supports and rafts of the model were printed by yellow filaments.The 3D models prepared by ABS filament can be sterilized. By bringing a sterilized 3D model into the clean operative field, the model is useful to dissect and identify the dominant perforators while raising the DIEP flap.