Person | TU Delft Repository

L. Brouwers

2 records found

Authored

Quality of life of patients with 3D-printed arm prostheses in a rural area of Sierra Leone

Journal article (2021) - A. J. Sterkenburg, M. van der Stelt, A. R. Koroma, M. D. Van Gaalen, M. J. Van der Pols, M. P. Grobusch, M. P. Grobusch, Cornelis H. Slump, T. J.J. Maal, L. Brouwers, L. Brouwers

Introduction: In Sierra Leone, access to prostheses is limited due to absence of practical knowledge, materials, trained staff, and high cost. This paper investigates the impact of a 3D printed prosthesis on the health-related quality of life (HRQoL) in prosthesis recipients. Methods: Patients with upper extremity amputations were included in this case study from December 2018 until July 2019. Data on the HRQoL was gathered until April 2020 in Masanga Hospital, central rural Sierra Leone. At two follow-up moments the HRQoL was assessed by applying the standard EQ-5D-5L questionnaire. These two follow-up moments varied between one week and just over a year after receiving the prosthesis. A second patient questionnaire was used to assess prosthesis satisfaction. Results: Seven patients were included. The results of the EQ-5D-5L questionnaire show no deterioration of the HRQoL in any patient and the overall HRQoL increased by almost 20% compared to the null measurement. One patient was lost to follow up after the first re-visit. The responses to the second questionnaire indicated that patients are satisfied with the prosthesis and use it in various situations. Patients often mentioned they feel more included in society when wearing the prosthesis. One patient says wearing the prosthesis helped in accepting the amputation. As a result, enough self-confidence was experienced without the prosthesis and the patients stopped wearing the prosthesis. Discussion: The overall HRQoL in patients wearing a 3D-printed prosthesis increases compared to not wearing one. Assessing the HRQoL at regular intervals is important for the long-term follow-up and to safeguard sustainability and long-term success of this project. Nevertheless, defining the HRQoL is challenging due to cultural differences and misunderstandings. Therefore, the use of alternative questionnaires to define the HRQoL should be investigated. To improve and warrant long-term success, identifying long-term problems is important, and the second questionnaire accounts for this need.

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Contributed

Effect of sterilization on 3D printed patient-specific surgical guides

Master thesis (2021) - V.H.A.M. van Dal, Jaap Harlaar, M. Bemelman, J. Zhou, J. Heyligers, L. Brouwers

Background The current workflow for the design and production of patient-specific surgical guides at the Elisabeth-TweeSteden hospital is out-sourced to external companies, making it a time-consuming and costly task. In order to minimize the production time and expenses, the design and fabrication of these guides could be implemented into the hospital’s workflow using an in-house available 3D printer. Compared to the current gold standard for the production of patient-specific surgical guides, a different printing technique and 3D print material will be used. Therefore, it should be determined whether these are suitable for the production of the guides. Moreover, the 3D printed models must be compatible with the in-house sterilization method in order to ensure quality and reliability. The aim of this thesis was to investigate the effect of the in-house available sterilization method on the mechanical, dimensional, and sterility properties of a novel biocompatible 3D printing material. Methods and results BioMed Clear resin specimens were tested according to the ISO standards for mechanical testing of plastics. Overall, steam sterilization changed the mechanical properties of the material, making it stronger and stiffer but more brittle, as compared to unsterilized specimens. The dimensional tests indicated that sterilization resulted in a dimensional change, up to 0.12 mm, which mostly occurred in the small crevices of the model. The deviations of the dimensions of the resulting 3D printed model compared to the digital 3D model were roughly less than 0.3 mm, which is comparable to the accuracy of the gold standard material, polyamide 12. Sterility tests showed that sterilization of the 3D printed models is indeed mandatory for the guides to be used intraoperatively. Also, the Central Sterile Services Department of the hospital is able to deliver sterile medical devices that can be stored for a minimum of four weeks at the sterile storage room. Conclusion With the feasibility confirmed for the hospital to be able to design and produce patient-specific surgical guides in-house, it is necessary to stress that the hospital must meet the Medical Device Regulations by complying with an appropriate quality management system, documenting the manufacturing process, evaluating the performance, and reviewing the experiences from clinical use.