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A trip ahead of the technology curve

Thursday 25 June 2020

A trip ahead of the technology curve – Dr Michael Wagels, the PA Hospital and 3D printed bone replacements

Princess Alexandra Hospital (PAH) Plastic and Reconstructive Surgeon Dr Michael Wagels' work in 3D printed bone implants has already seen he and his team rebuild both a patient's tibia and a patient's skull. Effectively acting as scaffolding, by design, the 3D printed bone implants promote the regrowth of natural bone.

As his 3D models head toward clinical trials, Dr Wagels shares credit with the PA Research Foundation (PARF), who have supported the surgeon over the past 18 months. With funding assistance from PARF, Dr Wagels travelled to Europe to make his vision a reality.

"We'd just done the world's first ever successful implant of an absorbable 3D printed device that was designed to turn into bone. We were all pretty pumped up after that. The whole team was thinking, "How do we make this a thing?" Not just a once off case," he said.

"It was clear from those discussions there was stuff going on elsewhere that we could learn from."

Dr Wagels focused his time in Europe on networking with other researchers, hospitals, and health systems to establish the best methods and workflows to bring back to Brisbane.

"You have to see, "what will work? what bits of those workflows can be integrated into our healthcare system and what bits can't? What have they done well? What have they done badly? what have they learned from their experience?"," Dr Wagels said.

"There's no way I could have gone on that trip without the support of PARF. It was a really important step in working out our own workflow. As soon as I got back, we started working out the key pieces that we needed to put into place.

"What it meant, was that in a year and a half, we've managed to focus on things we knew we needed to get done, prioritise things appropriately and not make the same mistakes other people had made - that would have seen us 10 years, or more, off the ball."

Dr Wagels and his team at the Australian Centre for Complex Integrated Surgical Solutions (ACCISS) have expanded their work to help train the next generation of doctors and surgeons, at the PAH and across Queensland. Dr Wagels' team have produced 3D printed models for training on airway management as well as broken hands and faces.

"These are 3D printed models with real fractures in them, before we had to get something that was off-the-shelf, a saw bone model, and break it ourselves. It never quite broke the way you wanted it to, which sounds minor, but it makes a difference," he said.

"We've got an entire education stream at ACCISS."

Working at the PAH campus, co-located with the Translational Research Institute (TRI), has been a "godsend" that Dr Wagels admits has propelled his work.

"I cannot tell you how awesome it is working here at the PA. I've worked through the alternative, which was every time I wanted a slight tweak to the implant, I had to drive over to QUT to talk to my engineers. I was happy to do it because I was passionate about the case, the patient, and fixing their problem," he said.

"It just makes life so much easier. You can get things done and get them done faster because you don't have to wait until next week to have that meeting.

"The resources available over at TRI are incredible. Just getting help with things like writing grant applications and putting together the ethics application. These things sound trivial but are incredibly important."

While adamant that 3D printing is not applicable or suitable for all conditions or injuries requiring surgery, with enough funding support Dr Wagels said the scope for medical purposed 3D printing was enormous, including regrowing cartilage and living joint replacements.

"I'm not sure we'll see living joint replacements in my lifetime, but it's something I will continue working on now that we can make bone. Can we make bone plus cartilage or an entire joint? Because missing joints are very hard to fix," he said.

"Then other tissue types like fat or at least something that's fat like for breast reconstruction. That's our latest venture, we've developed a scaffold that we know can help to regenerate fat in a pig model. We've got our first human trial coming up next month where we implant a scaffold and fill it up with the patient's own fat."

With a long segment bone defect trial soon underway, to validate the surgery done on a patient's leg in 2019, the best is yet to come for the ACCISS Team, meaning more patients at the PAH are set to benefit.

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