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PhD in Veterinary Sciences for Animal Health and Food Safety

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Luca Manassero

Phd thesis

Custom three-dimensional-printed surgical guide systems in veterinary surgery: a comparison with current surgical options in treatment of antebrachial angular deformities in dogs

● Scientific background/state of the art

In recent years, the application of three-dimensional (3D) printing technologies has become popular in veterinary medicine. This technology enables to plan complex surgeries, to create custom prosthetics and to get educational models (1,2). Among the latest innovations is the utilization of 3D printed custom surgical guides (CSG) to treat long bone angular deformities. The origin of angular deformities is due to growth disturbances which can result from trauma, genetic disorders, nutritional imbalances, or other disturbances of growth physis (3). Surgical correction is often recommended to prevent lameness and degenerative joint disease, but it represents a significant challenge for surgeons. Currently different surgical techniques, including freehand osteotomies, have been reported in dogs (4,5). These procedures have variable outcomes liable mainly on the complexity of the deformity and on the skill level of the surgeon. Some studies evaluated the ability to restore limb alignment with the Center of Rotation of Angulation (CORA) method (6) using closing wedge osteotomies with 3D printed custom surgical guides (CSG) reporting reduced surgical time and improved overall patient outcomes (7,8,9). The literature still lacks reports on the use of CSGs with opening wedge and neutral wedge osteotomies1 to avoid bone shortening. This project wants to explore the use of 3D printed CSGs in treating antebrachial deformities in dogs, focusing on opening and neutral wedge osteotomies.

● Aims

During the first year of the project, anatomically accurate 3D printed models representing different antebrachial deformities in dogs, along with their CSGs will be designed and produced, in order to perform osteotomies in an in vitro model.

Within the end of the second year of the project, the osteotomy procedure will be performed aiming to:

1. Compare the feasibility and effectiveness of freehand and 3D printed CSGs osteotomies in the treatment of three different groups of antebrachial deformities.

2. Assess the accuracy of freehand and 3D printed CSGs procedures, taking into consideration different levels of surgeon experience in the treatment of antebrachial deformities. This will help undertake if surgical outcomes of this complex pathologies can be standardized between experienced and novice surgeons.

3. Investigate the use of opening, neutral and closing wedge osteotomies techniques using 3D printed custom surgical guides (CSGs).

Within the first semester of the third year of the project, methods and groups of deformities will be compared, and the findings will be documented. A comprehensive paper detailing these results will be drafted and submitted for peer review. 

● Materials and methods

Three representative cases of antebrachial deformity belonging to unilaterally affected dogs will be selected from the CT database of the Ospedale Veterinario Universitario in Grugliasco. According to the CORA method, deformities will be categorized as:

1. simple uniapical;
2. complex uniapical;
3. complex non-compensated biapical.

Computer-aided Design (CAD) softwares will be used to assess the deformity, to virtually simulate the correction and to design CSGs for closing, opening and neutral wedge osteotomies. To obtain reproducibility and good statistical power, each deformity will be repeated 3 times resulting in 36 bone models for each group, for a total sample size of 108 models and 56 CSGs. Models will be 3D printed during the internationalization period in an external lab2.

Osteotomies on all bone models will be performed in the Department of Veterinary Sciences of Grugliasco by an experienced and a novice surgeon. Each procedure will be repeated using closing, opening and neutral wedge, with freehand technique and 3D printed CSGs. The accuracy of deformity correction will be assessed pre and post operatively with CT and radiology, measuring angles variation compared to the normal contralateral limb. Data will be tested for normality and t- test will be used to evaluate differences in alignment considering: the type of osteotomy (closing, opening and neutral), the experience of the surgeon (novice vs experienced) and the type of the surgical technique (freehand vs 3D printed CSGs).

 

● Expected results

The use of 3D printed CSGs can improve the accuracy of corrective osteotomies for treating antebrachial deformities in dogs compared to the freehand technique.

The use of 3D printed CSGs may demonstrate that this technique is effective even for novice surgeons, with overall accuracy and alignment outcomes comparable to those of experienced surgeons.

Opening and neutral wedge osteotomies still need to be assessed, and their use might provide advantages compared to closing wedge osteotomies in terms of bone length preservation and osteotomy stability.

Furthermore, the findings of this study are expected to underscore the effectiveness of 3D printed CSGs in managing complex deformities, such as biapical ones, suggesting that their application may be unnecessary for simpler, uniapical deformities, without regard to surgeon experience.

 

• Bibliography:

1) Hespel AM, Wilhite R, Hudson J. Invited review--Applications for 3D printers in veterinary medicine. Vet Radiol Ultrasound. 2014 Jul-Aug;55(4):347-58. doi: 10.1111/vru.12176.

2) Aimar A, Palermo A, Innocenti B. The Role of 3D Printing in Medical Applications: A State of the Art. J Healthc Eng. 2019 Mar 21;2019:5340616. doi: 10.1155/2019/5340616.

3) Fox DB. Physeal Injuries and Angular Limb Deformities. Vet Clin North Am Small Anim Pract. 2021 Mar;51(2):305-322. doi: 10.1016/j.cvsm.2020.11.003

4) Franklin SP, Dover RK, Andrade N, Rosselli D, M Clarke K. Correction of antebrachial angulation-rotation deformities in dogs with oblique plane inclined osteotomies. Vet Surg. 2017 Nov;46(8):1078-1085. doi: 10.1111/vsu.12706

5) Fox DB, Tomlinson JL, Cook JL, Breshears LM. Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs. Vet Surg. 2006 Jan;35(1):67-77. doi: 10.1111/j.1532- 950X.2005.00114.x.

6) Knapp JL, Tomlinson JL, Fox DB. Classification of Angular Limb Deformities Affecting the Canine Radius and Ulna Using the Center of Rotation of Angulation Method. Vet Surg. 2016 Apr;45(3):295-302. doi: 10.1111/vsu.12460.

7) Lee HR, Adam GO, Yang DK, Tungalag T, Lee SJ, Kim JS, Kang HS, Kim SJ, Kim NS. An Easy and Economical Way to Produce a Three-Dimensional Bone Phantom in a Dog with Antebrachial Deformities. Animals (Basel). 2020 Aug 19;10(9):1445. doi:10.3390/ani10091445

8) De Armond CC, Lewis DD, Kim SE, Biedrzycki AH. Accuracy of virtual surgical planning and custom three-dimensionally printed osteotomy and reduction guides for acute uni- and biapical correction of antebrachial deformities in dogs. J Am Vet Med Assoc. 2022 Apr 22;260(13):1-9. doi: 10.2460/javma.21.09.0419.

9) Worth AJ, Crosse KR, Kersley A. Computer-Assisted Surgery Using 3D Printed Saw Guides for Acute Correction of Antebrachial Angular Limb Deformities in Dogs. Vet Comp Orthop Traumatol. 2019 May;32(3):241-249. doi: 10.1055/s-0039-1678701

Research activities

Co supervisor

Prof. Marcin Basiaga

 

Publications:

  • Franci P, Santoro F, Landi A, Manassero L and Lardone E. Evaluation of the thoracic epidural spread after caudal thoracic contrast medium injections in cat cadavers Front. Vet. Sci. 2025; 12:1632175 doi: 10.3389/fvets.2025.1632175 (Veterinary Q1)

  • Giacobino D, Olimpo M, Ferraris EL, Martinelli G, Maniscalco L, Camerino M, Riccardo F, Cavallo F, Tarone L, Cino M, Dentini A, Iussich S, Lardone E, Manassero L, Maria RD, Buracco P, Morello E. Influence of the extent of cervical lymph node dissection and lymph nodes metastases on prognosis in a cohort of dogs with oral malignant melanoma treated by surgical resection and adjuvant anti-CSPG4 electrovaccination: a retrospective study on 77 cases. Front. Vet. Sci. 2025; 12:1616419 doi: 10.3389/fvets.2025.1616419 (Veterinary Q1)

  • Camerino M., Giacobino D., Tarone L., Dentini A, Martano M., Morello E., Ferraris E., Manassero L., Iussich S., Maniscalco L., Cavallo F., Riccardo F., Buracco P. Clinical evaluation of HuDo-CSPG4 DNA electroporation as adjuvanttreatment for canine oral malignant melanoma: comparison of two vaccination protocols. Veterinary Quarterly 2025; 45(1):1-16 doi: 10.1080/01652176.2025.2473717 (Veterinary Q1)

  • Serperi M., Bonaffini G., Ottino C., Quaranta G., Manassero L., Mauthe Von Degerfeld M. Conservative treatment of a synovial cyst in a golden eagle (Aquila chrysaetos) with triamcinolone acetonide. J. Vet. Med. Sci. 2024; 86(5): 592–595; doi:10.1098/rspb.2023.1029 (Veterinary Q2)

  • Favaro L., Zanoli A., Ludynia K., Snyman A., Carugati F., Friard O., Scaglione FE, Manassero L., Valazza A., Mathevon N., Gamba M., Reby D. Vocal tract shape variation contributes to individual vocal identity in African penguins. Proc. R. Soc. B. 2023 doi:10.1098/rspb.2023.1029 (Biological Sciences Q1)

  • Ferraris EL, Olimpo M, Giacobino D, Manassero L., Iussich S., Lardone E., Camerino M., Buracco P., Morello EM. Sentinel lymph node mapping with computed tomography lymphography for mast cell tumours and a comparison between regional and sentinel lymph node histological status: Sixty-two cases. Vet Comp Oncol. 2023; 21(2):208-220. doi:10.1111/vco.12878220 (Veterinary Q1)

  • Colitti B., Manassero L., Colombino E., Ferraris EI., Caccamo R., Bertolotti L., Bortolami A., Bonfante F., Papa V, Cenacchi G., Calabrese F., Bozzetta E., Varello K, Capucchio MT., Rosati S. Pulmonary fibrosis in a dog as a sequela of infection with Severe Acute Respiratory Syndrome Coronavirus 2? A case report. BMC Vet Res 2022; 18, 111. doi:10.1186/s12917-022-03191-x (Veterinary Q1)

  • Cagnotti G, Ferrini S, Di Muro G, Borriello G, Corona C, Manassero L, Avilii E, Bellino C, D’Angelo A. Constant rate infusion of diazepam or propofol for the management of canine cluster seizures or status epilepticus. Front. Vet. Sci. 2022; 9:1005948. doi:10.3389/fvets.2022.1005948 (Veterinary Q1)

  • Camerino M., Giacobino D., Manassero L., Iussich S., Riccardo F., Cavallo F., Tarone L., Olimpo M., Lardone E., Martano M., Del Magno S., Buracco P., Morello E. Prognostic impact of bone invasion incanine oral malignant melanoma treated by surgery and anti CSPG4 vaccination: A retrospective study on 68 cases (2010–2020). Vet Comp Oncol. 2022;20(1):189-197. doi:10.1111/vco.127 (Veterinary Q1)

  • Giacobino D., Camerino M., Riccardo F., Cavallo F., Tarone L., Martano M, Dentini A, Iussich S., Lardone E., Franci P., Valazza A., Manassero L., Del Magno S., De Maria R., Morello E., Buracco P. Difference in outcome between curative intent vs marginal excision as a first treatment in dogs with oral malignant melanoma and the impact of adjuvant CSPG4-DNA electrovaccination: A retrospective study on 155 cases. Vet Comp Oncol. 2021; 19:651–660. doi:10.1111/vco.12690 (Veterinary Q1)

Poster:

  • Mateusz Pawlik, Piotr Trębacz, Aleksandra Kurkowska, Anna Barteczko, Luca Manassero, Lisa Adele Piras, Davide Mancusi, Agata Piątek, Wojciech Kajzer. “In-house vs. outsourced 3D printing for surgical guides: a comparsion of brittleness and mechanical performance” in proceeding of ESVOT Congress 2025 (Palma di Mallorca, Spain). 

  • Manassero Luca, Serpieri Matteo, Pawlik Mateusz, Kurkowska Aleksandra, Bonaffini Giuseppe, Valazza Alberto, Giusto Gessica “Development of a 3D-printed guiding system for maxillary nerve block in rabbits” in proceeding of SISVET Congress 2025 (Giardini Naxos, Italy) – BEST POSTER AWARD

  • Luca Manassero, Lisa Adele Piras, Mateusz Pawlik, Piotr Trębacz, Davide Mancusi, Aleksandra Kurkowska, Agata Piątek, Magdalena Antonowicz. “Guide chirurgiche stampate in 3D: conseguenze della posticipazione dell’intervento” Poster Presentation, at SCIVAC Congress 2025 (Rimini, Italy)

  • Luca Manassero, Cecilia Pulcani, Erica Ilaria Ferraris, Arianna Scolaro, Andrea Degiovanni, Matteo Olimpo, Emanuela Morello, Alberto Valazza "The “Spaghetti Sign” in computed tomography: characterization of spleno-systemic shunts in cats" 4th edition of Game of Research, Turin (Italy); 12/12/2024. 

  • Camerino M, Giacobino D, Tarone L, Dentini A, Martano M, Morello E, Ferraris E I, Manassero L, Iussich S, Maniscalco L, Cavallo F, Riccardo F, Buracco P “Clinical evaluation of HuDo-CSPG4 DNA electroporation as adjuvant treatment for canine oral malignant melanoma: comparsion of two vaccination protocols”, in: Veterinary Cancer Society Annual Conference, Orlando (United States), 17-19/10/2024.

  • Pawlik M., Manassero L., Piras L., Vezzoni L., Trębacz P., Kurkowska A., Barteczko A., Marcin Basiaga M. (2024). Evaluation of 3D Printed Biomimetic Canine Antebrachial Deformity Orthopedic Training Models; in proceeding of the HealthTech Innovation Conference in Zabrze (Poland); 7-8/10/2024.
  • Manassero L., Rizzo S. G., Ferraris E. I., Olimpo M., Giacobino D., Ieva L., Valazza A., Morello E (2023). The use of computed tomographic lymphography for the identification of sentinel lymph node in cats with superficial solid tumors: a pilot study; 3rd Turin edition of Game of Research, Turin (Italy); 14/12/2023. 

  • Manassero L., Valazza A., Rizzo S. G., Olimpo M., Buracco P. (2022). Design of customized 3-dimensional-printed cranioplasty prosthesis in small animals with affordable biocompatible materials; 2nd Turin edition of Game of Research, Turin (Italy); 15/12/2022. 

Oral presentations:

  • Invited Speaker, at 3DHeals Webinar “3D Printing for Veterinary Medicine” with the presentation “Imaging acquisition guidelines for optimal 3D printing workflow in veterinary medicine” 15/3/25.

  • Speaker, at PhD Seminar of Unito in selected approaches in Veterinary Science research "3D Printing in Veterinary Medicine" of Dott. Mateusz Pawlik from Silesian University of Technology (Poland). Grugliasco, 1/4/25.

  • Oral Presentation, “Custom 3D-Printed Surgical Guides: The Ultimate Partner for Complex Veterinary Surgeries” Game of Research 2024, University of Turin, Department of Veterinary Sciences, Grugliasco, Italy. 12/12/25.

Last update: 18/09/2025 18:01

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