Arch Plast Surg.
2020 Sep;47(5):428-434. 10.5999/aps.2020.00829.
The utility of three-dimensional models in complex microsurgical reconstruction
- Ogunleye AA
1 - Deptula PL2
- Inchauste SM3
- Zelones JT4
- Walters S5
- Gifford K5
- LeCastillo C5
- Napel S5
- Fleischmann D5
- Nguyen DH2
- Affiliations
-
- 1Division of Plastic Surgery, University of North Carolina, Chapel Hill, NC, USA
- 2Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA
- 3Division of Plastic Surgery, University of Washington, Seattle, WA, USA
- 4Plastic and Hand Surgical Associates, South Portland, ME, USA
- 53D and Quantitative Imaging Lab, Department of Radiology, Stanford University, Palo Alto, CA, USA
- KMID: 2506694
- DOI: http://doi.org/10.5999/aps.2020.00829
Abstract
- Background
Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes.
Methods
A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision-making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction.
Results
Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group.
Conclusions
Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.
