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Study shows effectiveness of 3D printed guides in surgical removal of equine keratomas

The use of 3D-printed guides to aid surgical removal of a rare tumor known as keratoma from horses’ feet can result in faster and more accurate procedures when used with advanced imaging techniques, according to a new paper published by a team of University of Florida’s large animal surgeons.

Dr. Adam Biedrzycki, an assistant professor of large animal surgery at the UF College of Veterinary Medicine, was first author on the study, published Feb. 28 in Veterinary Surgery. Contributing authors included Drs. Alison Morton, Erik Perez-Jimenez, George Elane, Heather Roe and Kimberly Trolinger-Meadows.

The study’s objective was to report the technique, surgical approach and postoperative features in horses who had keratomas surgically removed with assistance from 3D printed guides that were created using computed tomography or magnetic resonance imaging.

“We wanted to demonstrate the advantage of using 3D-printed guides, but also to discuss how to make them using both CT and MRI,” Biedrzycki said. “Keratomas can be challenging to diagnose sometimes, and advanced imaging such as MRI sometimes has to be used. We therefore described how to make the guides from both CT and MRI. Hopefully, if anyone wishes to use this procedure, this paper will guide them through it.”

Five client-owned horses were in a short case series, with all horses being placed under general anesthesia for imaging and undergoing a second anesthesia for surgery. Two horses had guides created from CT-based imaging, and three had guides created from MRI. The surgical sites were managed until new connective tissue formed and the defect was sealed with an artificial hoof wall patch.

All of the keratomas were successfully removed as a single piece, either intact with the hoof wall or easily extracted after the hoof wall portal was created, in a time frame of between 20 and 90 minutes. All of the CT-created guides fitted without issue; the MRI-created guides required minor adjustments with a Dremel device for proper fit.

“The surgery is fairly simple; you get access to the hoof and remove the keratoma,” Biedrzycki said. “The guides help to visualize and target the keratoma, which we can usually see on the imaging. This helps us make sure we map it out and the entire keratoma is removed using as small of a portal as possible.”

Although there were only five cases included in the report, Biedrzycki said he has now performed about a dozen such surgeries.

“People say they have heard about 3D printing at UF, and would like to have this procedure done in this way,” he said, adding that while the use of 3D printing is common in several small animal hospitals, to the best of his knowledge, UF has the only equine hospital that routinely makes use of the technique to aid in surgical procedures.