Main Article Content
CTA, perforator flap, augmented reality, technology, reconstruction
Introduction: Free tissue transfer has become a mainstay in reconstructive plastic surgery, and techniques to plan such surgery continue to evolve. Novel technologies and increases in computational power have enabled computed tomographic angiography (CTA)data augmentation onto patients to assist in pedicle identification and dissection. Given the rapidly evolving field and research in this domain, a systematic re-view was undertaken to establish the evidence for its usefulness in pedicle identification and dissection.
Methods: An extensive search using keywords in EMBASE and PubMed with bibliographic linkage following PRISMA guidelines was performed. 107 articles were identified. Duplicate articles were removed prior to review. Two reviewers independently screened the titles for appropriate topic relevance. Full articles were then screened for review.
Results: Eleven articles were appropriate for review. Two articles analysed the time taken to identify perfo-rators using augmented reality (AR) compared to Doppler ultrasound. The remainder of the articles ana-lysed time to perforator identification, differences between projected location and dissected perforator location, qualitative feedback from surgeons on the use of AR systems for perforator identification and proof of concept and the usefulness of AR in perforator flap surgery.
Conclusion: This review demonstrates that while established methods of data rendering and projection can achieve holographic projection and AR, there is a lack of objective outcome data to demonstrate its usefulness. This, combined with a cost analysis, are the main obstructions to this technology being more widely adopted.
2. Rozen WM, Anavekar NS, Ashton MW, Stella DL, Grinsell D, Bloom RJ, Taylor GI. Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction? Microsurgery. 2008;28(7):516–23. https://doi.org/10.1002/micr.20526. PMid:18683872
3. Giunta RE, Geisweid A, Feller AM. The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg. 2000;105(7):2381–386. https://doi.org/10.1097/00006534-200006000-00011. PMid:10845290
4. Ensat F, Babl M, Conz C, Fichtl B, Herzog G, Spies M. Doppler sonography and colour Doppler sonography in the preoperative assessment of anterolateral thigh flap perforators. Handchir Mikrochir Plast Chir. 2011;43(2):71–75. https://doi.org/10.1055/s-0030-1255071. PMid:20603786
5. Rozen WM, Garcia-Tutor E, Alonso-Burgos A, Acosta R, Stillaert F, Zubieta JL, Hamdi M, Whitaker IS, Ashton MW. Planning and optimising DIEP flaps with virtual surgery: the Navarra experience. J Plast Reconstr Aesthet Surg. 2010;63(2):289–97. https://doi.org/10.1016/j.bjps.2008.10.007. PMid:19042174
6. Rozen WM, Ashton MW, Pan WR, Kiil BJ, McClure VK, Grinsell D, Stella DL, Corlett RJ. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery. 2009;29(1):16–23. https://doi.org/10.1002/micr.20550. PMid:18942652
7. Pratt P, Ives M, Lawton G, Simmons J, Radev N, Spyropoulou L, Amiras D. Through the HoloLens looking glass: augmented reality for extremity reconstruction surgery using 3D vascular models with perforating vessels. Eur Radiol Exp. 2018;2(1):2. https://doi.org/10.1186/s41747-017-0033-2. PMid:29708204 PMCid:PMC5909360
8. Jiang T, Zhu M, Zan T, Gu B, Li Q. A novel augmented reality-based navigation system in perforator flap transplantation: a feasibility study. Ann Plast Surg. 2017;79(2):192–96. https://doi.org/10.1097/SAP.0000000000001078. PMid:28509695
9. Bosc R, Fitoussi A, Pigneur F, Tacher V, Hersant B, Meningaud JP. Identification of perforating vessels by augmented reality: application for the deep inferior epigastric perforator flap. Ann Chir Plast Esthet. 2017;62(4):336–39. https://doi.org/10.1016/j.anplas.2017.01.002. PMid:28283212
10. Wesselius TS, Meulstee JW, Luijten G, Xi T, Maal TJJ, Ulrich DJO. Holographic augmented reality for DIEP flap harvest. Plast Reconstr Surg. 2021;147(1):25e–9e. https://doi.org/10.1097/PRS.0000000000007457. PMid:33370048
11. Nuri T, Mitsuno D, Iwanaga H, Otsuki Y, Ueda K. Application of augmented reality (AR) technology to locate the cutaneous perforator of anterolateral thigh perforator flap: a case report. Microsurgery. 2021. https://doi.org/10.1002/micr.30735. PMid:33786854
12. Hummelink S, Hameeteman M, Hoogeveen Y, Slump CH, Ulrich DJ, Schultze Kool LJ. Preliminary results using a newly developed projection method to visualize vascular anatomy prior to DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg. 2015;68(3):390–94. https://doi.org/10.1016/j.bjps.2014.11.006. PMid:25498828
13. Hummelink S, Hoogeveen YL, Schultze Kool LJ, Ulrich DJO. A new and innovative method of preoperatively planning and projecting vascular anatomy in DIEP flap breast reconstruction: a randomized controlled trial. Plast Reconstr Surg. 2019;143(6):1151e–8e. https://doi.org/10.1097/PRS.0000000000005614. PMid:31136470
14. Hummelink S, Verhulst AC, Maal TJJ, Hoogeveen YL, Schultze Kool LJ, Ulrich DJO. An innovative method of planning and displaying flap volume in DIEP flap breast reconstructions. J Plast Reconstr Aesthet Surg. 2017;70(7):871–75. https://doi.org/10.1016/j.bjps.2017.04.008. PMid:28528800
15. Sotsuka Y, Matsuda K, Fujita K, Fujiwara T, Kakibuchi M. Image overlay of deep inferior epigastric artery in breast reconstruction. Plast Reconstr Surg Glob Open. 2014;2(10):e235. https://doi.org/10.1097/GOX.0000000000000210. PMid:25426352 PMCid:PMC4236380
16. Cifuentes IJ, Dagnino BL, Salisbury MC, Perez ME, Ortega C, Maldonado D. Augmented reality and dynamic infrared thermography for perforator mapping in the anterolateral thigh. Arch Plast Surg. 2018;45(3):284–88. https://doi.org/10.5999/aps.2017.01375. PMid:29788686 PMCid:PMC5968320
17. Pereira N, Kufeke M, Parada L, Troncoso E, Bahamondes J, Sanchez L, Roa R. Augmented reality microsurgical planning with a smartphone (ARM-PS): a dissection route map in your pocket. J Plast Reconstr Aesthet Surg. 2019;72(5):759–62. https://doi.org/10.1016/j.bjps.2018.12.023. PMid:30611677
18. Caudell TP, Mizell DW, editors. Augmented reality: an application of heads-up display technology to manual manufacturing processes. International Conference on System Sciences; 1992 1992; Hawaii, USA1992.
19. Mann S. Wearable computing: a first step toward personal imaging. Computer. 1997;30(2):25–32. https://doi.org/10.1109/2.566147.
20. Zeng B, Meng F, Ding H, Wang G. A surgical robot with augmented reality visualization for stereoelectroencephalography electrode implantation. Int J Comput Assist Radiol Surg. 2017;12(8):1355–368. https://doi.org/10.1007/s11548-017-1634-1. PMid:28664416
21. Stranix JT, Stern CS, Rensberger M, Ganly I, Boyle JO, Allen RJ, Disa JJ, Mehrara BJ, Garfein ES, Matros E. A virtual surgical planning algorithm for delayed maxillomandibular reconstruction. Plast Reconstr Surg. 2019;143(4):1197–206. https://doi.org/10.1097/PRS.0000000000005452. PMid:30676509 PMCid:PMC6438755
22. Rose EH, Norris MS, Rosen JM. Application of high-tech three-dimensional imaging and computer-generated models in complex facial reconstructions with vascularized bone grafts. Plast Reconstr Surg. 1993;91(2):252–64. https://doi.org/10.1097/00006534-199302000-00007. PMid:8304990
23. Murphy RJ, Liacouras PC, Grant GT, Wolfe KC, Armand M, Gordon CR. A craniomaxillofacial surgical assistance workstation for enhanced single-stage reconstruction using patient-specific implants. J Craniofac Surg. 2016;27(8):2025–30. https://doi.org/10.1097/SCS.0000000000003106. PMid:28005747
24. Marzano E, Piardi T, Soler L, Diana M, Mutter D, Marescaux J, Pessaux P. Augmented reality-guided artery-first pancreatico-duodenectomy. J Gastrointest Surg. 2013;17(11):1980–983. https://doi.org/10.1007/s11605-013-2307-1. PMid:23943389
25. Tagaya N, Aoyagi H, Nakagawa A, Abe A, Iwasaki Y, Tachibana M, Kubota K. A novel approach for sentinel lymph node identification using fluorescence imaging and image overlay navigation surgery in patients with breast cancer. World J Surg. 2011;35(1):154–58. https://doi.org/10.1007/s00268-010-0811-y. PMid:20931198
26. Kim Y, Kim H, Kim YO. Virtual reality and augmented reality in plastic surgery: a review. Arch Plast Surg. 2017;44(3):179–87. https://doi.org/10.5999/aps.2017.44.3.179. PMid:28573091 PMCid:PMC5447526
27. Chae MP, Ganhewa D, Hunter-Smith DJ, Rozen WM. Direct augmented reality computed tomographic angiography technique (ARC): an innovation in preoperative imaging. Eur J Plast Surg. 2018;41(4):415–20. https://doi.org/10.1007/s00238-018-1395-2.
28. Glamox. Operation Rooms. [Available from: https://glamox.com/uk/solutions/operation-rooms.]
29. Losken A, Seify H, Denson DD, Paredes AA Jr., Carlson GW. Validating three-dimensional imaging of the breast. Ann Plast Surg. 2005 disc 7–8;54(5):471–76. https://doi.org/10.1097/01.sap.0000155278.87790.a1. PMid:15838205