Dr. Xu Guo-Feng, Attending Physician, Department of Plastic Surgery
With advancements in medical technology and team collaboration, plastic surgery has evolved beyond mere "aesthetic sculpture" to become a powerful force in restoring dignity to life. The plastic surgery team at Tri-Service General Hospital has successfully completed numerous complex craniofacial reconstruction surgeries by integrating 3D printing-assisted navigation technology and cross-disciplinary treatment, showcasing Taiwan’s leadership in craniofacial reconstruction.
3D Printing in Craniofacial Reconstruction: Precisely Reshaping Skeletal Structures
Dr. Hsu, Kuo-Feng, Attending Physician in Plastic Surgery, shares a remarkable case: a gunshot injury involving a patient struggling with depression. After a sudden breakup with girlfriend, the patient attempted suicide with a T91 rifle, resulting in severe facial trauma, shattered facial bones, airway obstruction, and even exposed brain tissue. Following emergency care at Tamsui Mackay Memorial Hospital, the patient was fortunate to survive.
Upon transfer to Tri-Service General Hospital’s Burn and Trauma Center, the medical team immediately initiated a multidisciplinary treatment meeting, embarking on a "reconstruction battle" that combined both technology and humanity. Traditional craniofacial reconstruction surgeries rely on the surgeon’s experience to repeatedly adjust bone to desired angles and position, which can be time-consuming and limited in precision. The plastic surgery team pioneered the use of 3D printed models to assist in surgical planning. Before surgery, virtual reconstruction technology was used to simulate structures like the mandible, frontal and nasal bones, and in surgery, precise bone cuts were performed under cutting guide and templates, significantly reducing operation time and improving reconstruction accuracy. For example, in the mandible reconstruction, the 3D printed template accurately planned the fibula transplant’s angle and position, reducing adjustment time during surgery and ensuring a more natural appearance and bite function after reconstruction.
Cross-Disciplinary Teamwork: Successful Reconstruction of Multiple Facial Traumas
Dr. Hsu elaborates further on this severe craniofacial injury case: The patient’s trauma resulted in multiple facial fractures and soft tissue defects. The treatment team integrated specialists from neurosurgery, oral and maxillofacial surgery, otolaryngology, thoracic surgery, and plastic surgery to conduct staged treatments, including debridement, skull reconstruction, and flap repair. Neurosurgery performed cranial debridement and artificial meninges coverage, while plastic surgery used an anterolateral thigh free flap to reconstruct the forehead, nasal septum, and hard palate defects. The final outcome was a dual restoration of appearance and function. Flaps survived well post-operation, and after multiple flap refinements and endoscopic follow-ups, the patient regained breathing and eating functions. The patient later underwent nasal reconstruction surgery and recovered a natural appearance. One year after the reconstruction (five months after nasal reconstruction), the patient had successfully reintegrated into society.
Meticulous "Craniofacial Art": Integrating Medicine and Aesthetics
The medical team followed the principle of "Replaced like with like" for reconstruction, emphasizing the repair of defects with the most similar tissues, while balancing appearance and functional restoration. In this case, the team innovatively used a 3D virtual model to reconstruct the patient’s missing frontal and nasal bones, designing supporting implants with various angles and lengths based on the "golden ratio" of the face. This technique combined hand-carved bone graft (rib) and structural rhinoplasty, giving the patient natural, three-dimensional facial proportions. The introduction of this technology not only improved the precision of aesthetic reconstruction but also symbolizes the shift of plastic surgery from functional restoration to "medical aesthetics."
Professional Support and Technological Assistance Guarding the Reconstruction Path
Tri-Service General Hospital’s plastic surgery team is supported by two major pillars—the Burn and Trauma ICU (BC-ICU) and the National Skin Bank. From emergency treatment and surgical planning to postoperative care, every step relies on highly coordinated professional support. The BC-ICU provides excellent care environments and experienced specialist nursing, while the Skin Bank offers temporary coverage materials for large wounds. The doctors emphasize that the key to successful reconstruction lies in "timely assessment, interdisciplinary collaboration, and precise execution of plans." This achievement is not only a technical success but also a testament to the trust and communication within the team.
Looking Forward: The New Era of 3D Navigation and Smart Surgery
With the introduction of advanced equipment like the Brainlab craniofacial navigation system, plastic surgery is entering the era of digitalization and computer aided reconstruction. In the future, virtual surgical planning and real-time navigation will enable surgeons to achieve even greater precision and safety in craniofacial reconstructions, facial bone fractures, and post-tumor removal reconstructions. This will not only enhance medical quality but also open up new opportunities for patients to experience rebirth.