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past 30 years, [12,13] it is only the last decade that has seen its rapid development as part of the fourth industrial revolution. [14] This change in practice is evidenced by the significant fraction of recent literature describing advances in 3D printed prostheses, including technological advances [4,15-18] and clinical reports. [19,20] Further innovations involving collaborations between clinicians, academics, and industry, promise even greater capabilities. The future will see 3D printers that can mix materials as desired during fabrication [21] and those that can 3D print organic semiconductors and piezoelectric polymers for sensing and bionics [22-24] (Figure 1). This report is focused on polymers for soft tissue, external, personalized, prosthetics with clinical applications for the ear, [25] nose, [26] eye, [27] face, [28] breast, [29] and hand. [30] The characteristics of both traditional and 3D printable polymeric materials, as well as current advanced manufacturing technologies and those in development, are also reviewed. The earliest evidence of prosthetics dates back to ≈2300 BC, where Egyptian mummies have been discovered with eye, nose, and genital reconstructions fashioned from plaster packed with mud, sand, linen, butter, or soda (Figure 1). [31] Wood, cloth, natural waxes, resins, and metals were later used as the material of choice for rudimentary prostheses. [32] Prostheses remained relatively unchanged for thousands of years until the 16th century, where prosthetic noses and eyes were made from parchment, wax, wood, hard rubber, gold, silver, and copper. [33] Metals continued as a fundamental material throughout the 19th century, largely due to their ability to be shaped and molded as needed. [34,35] One of the first polymers to be used in prosthetics, poly(methyl methacrylate) (PMMA), was developed in response to the glass shortages in the World Wars of the 20th Century. [36] This polymer went on to become the most common prosthetic material of the time, and still finds use today in artificial eyes [33] and prosthetic substructures. [37] Further innovations in the 20th century produced many new polymers, such as vinyls, copolymers, plastisols, and one of the most significant materials in prosthetics, silicone. [38] Discovered in the early 1900s by Fredrick Kipping, silicone was first used in prosthetics by George W Barnhart in 1960. [39] This versatile polymer remains a primary prosthetic material today due to its soft tissue-like properties, ease of manipulation, chemical inertness, durability, and excellent biocompatibility. [40,41] The search for alternative materials Millions of people worldwide experience disfigurement due to cancers, congenital defects, or trauma, leading to significant psychological, social, and economic disadvantage. Prosthetics aim to reduce their suffering by restoring aesthetics and function using synthetic materials that mimic the characteristics of native tissue. In the 1900s, natural materials used for thousands of years in prosthetics were replaced by syntheti...

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Physical disfigurement due to congenital defects, trauma, or cancer causes considerable distress and physical impairment for millions of people worldwide; impacting their economic, psychological and social wellbeing. Since 3000 B.C., prosthetic devices have been used to address these issues by restoring both aesthetics and utility to those with disfigurement. Internationally, academic and industry researchers are constantly developing new materials and manufacturing techniques to provide higher quality and lower cost prostheses to those people who need them. New advanced technologies including 3D imaging, modeling, and printing are revolutionizing the way prostheses are now made. These new approaches are disrupting the traditional and manual art form of prosthetic production which are laborious and costly and are being replaced by more precise and quantitative processes which enable the rapid, low cost production of patient-specific prostheses. In this two part review, we provide a comprehensive report of past, present and emerging soft-tissue prosthetic materials and manufacturing techniques. In this review, part A, we examine, historically, the ideal properts of a polymeric material when applied in soft-tissue prosthetics. We also detail new research approaches to target specific tissues which commonly require aesthetic restoration (e.g. ear, nose and eyes) and discuss both traditional and advanced fabrication methods, from hand-crafted impression based approaches to advanced manufactured prosthetics. We discuss the chemistry and related details of most significant synthetic polymers used in soft-tissue prosthetics in Part B. As advanced manufacturing transitions from research into practice, the five millennia history of prosthetics enters a new age of economic, personalized, advanced soft tissue prosthetics and with this comes significantly improved quality of life for the people affected by tissue loss.

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