In this article we are sharing Dr. Amanda Mayo’s story. It was published on April 25, 2024, by The Temerty Faculty of Medicine at the University of Toronto.
I conducted research on The Temerty Faculty of Medicine at the University of Toronto and Sunnybrook Research Institiute before writing Dr. Amanda Mayo’s narrative.
Over 10,000 Ukrainians have been critically injured since the beginning of the war in February 2022, necessitating the amputation of one or more limbs. Limb loss patients have had difficulty accessing prostheses due to a lack of clinicians equipped to fabricate prostheses in the country and time constraints associated with manual fabrication methods, with some travelling abroad to receive prosthetic limbs and rehabilitation.
Due to border restrictions, this process is more complex.
Dr. Amanda Mayo is a Clinician in Quality Improvement (QI) Physiatrist at Sunnybrook Health Sciences Centre and an Assistant Professor in the Department of Medicine at the University of Toronto.
She finished medical school and her residency at the University of Toronto, and she now focuses in amputee rehabilitation. Her current QI priorities include enhancing the continuum of care for people with limb loss. In addition, it prevents dysvascular amputations.
“U of T feels like home to me and I really like how collaborative we are within the Department of Medicine,” she says. “If you need something, there’s always somebody at U of T that can help you clinically or academically, and I have been blessed with great mentorship and resources by being a U of T faculty member.”
In spring of 2022, Dr. Mayo and her team, including Dr. Peter Derkach, hospitalist at West Park Healthcare Centre, Jerry Evans, CEO of Nia Technologies, Dr. Myroslava Romach, Psychiatrist at Sinai Health System and Professor of Psychiatry at U of T, Dr. Steven Dilkas, Amputee Physiatrist at West Park Healthcare Centre and Assistant Professor of Physical Medicine & Rehabilitation at U of T, and Arezoo Eshraghi, certified prosthetist at West Park Healthcare Centre, linked with Unbroken, a rehabilitation center in Lviv, Ukraine that has provided medical assistance to over 15,000 Ukrainians injured by the war.
The group’s specialties include reconstructive surgery, orthopedics, and prosthetics.
The majority of lower limb amputations worldwide are caused by diabetes and/or vascular disease complications. Traumatic war injuries, on the other hand, can result in more complex limb loss instances, such as tourniquet-induced short arm and hip amputations, gunshot wounds, and explosive traumas.
Unbroken sought Dr. Mayo’s and her colleagues’ expertise after learning that Sunnybrook was Canada’s leading trauma clinic as well as a provincial center for upper extremity and rare forms of prosthesis.
“Traditionally, prosthesis production involves creating a manual plaster cast of the residual limb and using that to produce a prosthetic socket. This requires about eight hours of manual labour per socket, so you can imagine how much time that takes a medical team with such a high volume of complex cases,” says Dr. Mayo.
“When we initially conducted a needs assessment with Unbroken, they expressed interest in learning how to 3D print prostheses in order to expand the capacity of their team.”
The residual limb can be scanned with a tablet or phone scanner, and any necessary changes can be done on a computer to create a digital socket for 3D printing. The prosthetic socket is then 3D printed in just a few hours, eliminating the need for hours of human labour.
Another advantage of 3D printing is that a digital file can be quickly replicated, however if a physically manufactured socket is lost or broken, it will take another eight hours of labour to recreate.
The partnership’s goals were straightforward: enhance prosthetic lab capacity, hence reducing fabrication time and manual labour, and provide Ukrainians with prosthetic fabrication and fitting services in their native country.
The Temerty Faculty of Medicine’s Temerty Toronto-Ukraine Education and Collaboration Fund at the University of Toronto provided funding for Dr. Mayo’s project in December 2022. That same month, some team members paid a personal visit to Unbroken’s medical facility in Lviv to survey and prepare it.
Lviv had received all of the essential equipment by June 2023.
“We sourced the 3D printers in Ukraine, which was challenging but will allow them to repair and replace parts more easily, and then the filament we ended up getting from other countries in Europe, so the only things we physically brought over were the iPads, laptops and software,” says Dr. Mayo.
The team returned to Lviv in August 2023 to train clinicians on how to use the technology, and by October, Unbroken’s medical staff had begun fitting patients with 3D printed sockets.
Unbroken is already producing 3D printed prostheses on its own, with Dr. Mayo and other project partners offering virtual assistance.
“They are exceeding expectations,” Dr. Mayo says. “The team over there has been sending us videos of patients walking and running on the sockets they’ve produced and they’ve now reduced the timeline for socket production down to two hours, so they have become very adept. At this point, I think we can learn a few things from them as far as their digital workflow.”
For further information feel free to visit Unbroken, Nia Technologies, Sunnybrook Research Institiute and The Temerty Faculty of Medicine at the University of Toronto.
