A Preliminary Study for an Intraoperative 3D Bioprinting Treatment of Severe Burn Injuries

Abstract

Background: Intraoperative three-dimensional fabrication of living tissues could be the next biomedical revolution in patient treatment. Approach: We developed a surgery-ready robotic three-dimensional bioprinter and demonstrated that a bioprinting procedure using medical grade hydrogel could be performed using a 6-axis robotic arm in vivo for treating burn injuries. Results: We conducted a pilot swine animal study on a deep third-degree severe burn model. We observed that the use of cell-laden bioink as treatment substantially affects skin regeneration, producing in situ fibroblast growth factor and vascular endothelial growth factor, necessary for tissue regeneration and re-epidermalization of the wound. Conclusions:We described an animal study of intraoperative three-dimensional bioprinting living tissue. This emerging technology brings the first proof of in vivo skin printing feasibility using a surgery-ready robotic arm-based bioprinter. Our positive outcome in skin regeneration, joined with this procedure's feasibility, allow us to envision the possibility of using this innovative approach in a human clinical trial in the near future.

Point of care approaches to 3D bioprinting for wound healing applications

“…Ultimately, the image acquisition method should offer the highest possible resolution while not compromising efficiency, nor adding significantly to the cost of treatment. Proposed wound image acquisition methods in the literature include hyperspectral imaging and colour segmentation [41], laser scanning [40], structured light scanning [39], and the use of displacement sensors [38]; each with advantages and limitations briefly outlined in table 2. It is well understood that resolution at this stage of the printing protocol will define quality of the final product, however, there is a fine balance to be maintained in order to avoid significantly compromising time to wound closure and overall system cost.…”

“…Although DLP and laser-assisted systems have made their debut as prospective in-situ bioprinting tools to regenerate cartilage [45] and bone [46], it is inkjet [40,47,48] and extrusion-based techniques [8,[36][37][38][39]41] that have been investigated to date as potential bedside strategies for in-situ skin substitute delivery. This is likely due to the ease of upscaling to increase volumetric output and cater for larger wound areas.…”

Intraoperative Creation of Tissue-Engineered Grafts with Minimally Manipulated Cells: New Concept of Bone Tissue Engineering In Situ

“…Potentially, bone marrow aspirate cells or bone marrow mononuclear cells isolated intraoperatively may also be incorporated into the bioink for intraoperative production of 3D bioprinted grafts. Several successful attempts have been made to adapt various bioprinting technologies for intraoperative tissue engineering [ 98 , 99 ]. Laser-assisted bioprinting with photoactivated gel could become a reliable tool in orthopedic surgery in the future for osteochondral repairing and cartilage engineering in situ [ 100 , 101 ].…”

Within or Without You? A Perspective Comparing In Situ and Ex Situ Tissue Engineering Strategies for Articular Cartilage Repair

“…[122] Complementary to this is the development of multi-axis robotic arm based bioprinters which offer the potential to deposit bio-inks within crevices or under overhangs of native tissue. [123] Adapting these advances to cartilage repair will require high resolution printing systems, since the heterogeneous layers within articular cartilage have thicknesses on the order of 200 μm, however the lack of a requirement for integrating vascular systems may make cartilage a more accessible target for these technologies compared with other tissues.…”