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Mayer HF, Coloccini A, Viñas JF. Three-Dimensional Printing in Breast Reconstruction: Current and Promising Applications. J Clin Med 2024; 13:3278. [PMID: 38892989 PMCID: PMC11172985 DOI: 10.3390/jcm13113278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Three-dimensional (3D) printing is dramatically improving breast reconstruction by offering customized and precise interventions at various stages of the surgical process. In preoperative planning, 3D imaging techniques, such as computer-aided design, allow the creation of detailed breast models for surgical simulation, optimizing surgical outcomes and reducing complications. During surgery, 3D printing makes it possible to customize implants and precisely shape autologous tissue flaps with customized molds and scaffolds. This not only improves the aesthetic appearance, but also conforms to the patient's natural anatomy. In addition, 3D printed scaffolds facilitate tissue engineering, potentially favoring the development and integration of autologous adipose tissue, thus avoiding implant-related complications. Postoperatively, 3D imaging allows an accurate assessment of breast volume and symmetry, which is crucial in assessing the success of reconstruction. The technology is also a key educational tool, enhancing surgeon training through realistic anatomical models and surgical simulations. As the field evolves, the integration of 3D printing with emerging technologies such as biodegradable materials and advanced imaging promises to further refine breast reconstruction techniques and outcomes. This study aims to explore the various applications of 3D printing in breast reconstruction, addressing current challenges and future opportunities.
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Affiliation(s)
- Horacio F. Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), Buenos Aires C1053ABH, Argentina; (A.C.); (J.F.V.)
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陈 超, 刘 云, 徐 加, 姜 献, 郑 传, 葛 明, 程 康. [Accurate tissue flap reconstruction method based on the quadratic surface developability for head and neck soft tissue defects]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:1175-1184. [PMID: 38151941 PMCID: PMC10753305 DOI: 10.7507/1001-5515.202305011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/31/2023] [Indexed: 12/29/2023]
Abstract
Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.
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Affiliation(s)
- 超 陈
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术国家级国际联合研究中心(杭州 310023)National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 云峰 刘
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术国家级国际联合研究中心(杭州 310023)National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 加杰 徐
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 献峰 姜
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 传铭 郑
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 明华 葛
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
| | - 康杰 程
- 浙江工业大学 机械工程学院(杭州 310023)College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术教育部/浙江省重点实验室(杭州 310023)Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China
- 浙江工业大学 特种装备制造与先进加工技术国家级国际联合研究中心(杭州 310023)National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China
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Kirloskar KM, Haffner ZK, Abadeer A, Yosaitis J, Baker SB. The Innovation Press: A Primer on the Anatomy of Digital Design in Plastic Surgery. Ann Plast Surg 2023; 91:307-312. [PMID: 37489974 DOI: 10.1097/sap.0000000000003617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
ABSTRACT Three-dimensional (3D) printing continues to revolutionize the field of plastic surgery, allowing surgeons to adapt to the needs of individual patients and innovate, plan, or refine operative techniques. The utility of this manufacturing modality spans from surgical planning, medical education, and effective patient communication to tissue engineering and device prototyping and has valuable implications in every facet of plastic surgery. Three-dimensional printing is more accessible than ever to the surgical community, regardless of previous background in engineering or biotechnology. As such, the onus falls on the surgeon-innovator to have a functional understanding of the fundamental pipeline and processes in actualizing such innovation. We review the broad range of reported uses for 3D printing in plastic surgery, the process from conceptualization to production, and the considerations a physician must make when using 3D printing for clinical applications. We additionally discuss the role of computer-assisted design and manufacturing and virtual and augmented reality, as well as the ability to digitally modify devices using this software. Finally, a discussion of 3D printing logistics, printer types, and materials is included. With innovation and problem solving comprising key tenets of plastic surgery, 3D printing can be a vital tool in the surgeon's intellectual and digital arsenal to span the gap between concept and reality.
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Affiliation(s)
| | | | - Andrew Abadeer
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
| | | | - Stephen B Baker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital
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Ibelli TJ, Chennareddy S, Mandelbaum M, Henderson PW. Vascular Mapping for Abdominal-Based Breast Reconstruction: A Comprehensive Review of Current and Upcoming Imaging Modalities. EPLASTY 2023; 23:e44. [PMID: 37664815 PMCID: PMC10472443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Preoperative vascular imaging is a very common element of surgical planning for abdominal-based breast reconstruction (ABBR). Surgeons must tailor which flap is best suited for each respective patient based on the patient's health and vascular anatomy. The goal of this review is to give surgeons practical tools for choosing which imaging technology best suits their patient's needs for successful breast reconstruction. Methods A review of literature was undertaken on Google scholar to assess preoperative imaging modalities used for ABBR. Search terms included breast reconstruction, deep inferior epigastric perforator (DIEP) flap, and abdominal imaging. Articles were included based on relevance and significance to ABBR. Advantages and disadvantages of each imaging modality were then classified according to clinically relevant utility. Results Overall, imaging technologies that produce 3-dimensional images were found to have greater resolution for identifying perforators and the pedicle network than 2- dimensional images. Conclusions This paper addresses the strengths and weaknesses of the currently used imaging modalities described and also discusses new technologies that may be helpful in the future for planning of ABBR.
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Affiliation(s)
- Taylor J Ibelli
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sumanth Chennareddy
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Max Mandelbaum
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Knoedler L, Knoedler S, Kauke-Navarro M, Knoedler C, Hoefer S, Baecher H, Gassner UM, Machens HG, Prantl L, Panayi AC. Three-dimensional Medical Printing and Associated Legal Issues in Plastic Surgery: A Scoping Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4965. [PMID: 37124385 PMCID: PMC10145872 DOI: 10.1097/gox.0000000000004965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Abstract
Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon's workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes.
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Affiliation(s)
- Leonard Knoedler
- From the Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Samuel Knoedler
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Christoph Knoedler
- Faculty of Applied Social and Health Sciences, Regensburg University of Applied Sciences, Regensburg, Germany
| | - Simon Hoefer
- Faculty of Law, University of Regensburg, Regensburg, Germany
| | - Helena Baecher
- From the Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Hans-Guenther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Prantl
- From the Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Adriana C. Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
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Using Virtual Reality for Deep Inferior Epigastric Perforator Flap Preoperative Planning. Plast Reconstr Surg Glob Open 2023; 11:e4773. [PMID: 36660058 PMCID: PMC9842250 DOI: 10.1097/gox.0000000000004773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/21/2022] [Indexed: 01/21/2023]
Abstract
This study was designed to compare VR stereoscopical three-dimensional (3D) imaging with two-dimensional computed tomography angiography (CTA) images for evaluating the abdominal vascular anatomy before autologous breast reconstruction. Methods This prospective case series feasibility study was conducted in two tertiary medical centers. Participants were women slated to undergo free transverse rectus abdominis muscle, unilateral or bilateral deep inferior epigastric perforator flap immediate breast reconstruction. Based on a routine CTA, a 3D VR model was generated. Before each procedure, the surgeons examined the CTA and then the VR model. Any new information provided by the VR imaging was submitted to a radiologist for confirmation before surgery. Following each procedure, the surgeons completed a questionnaire comparing the two methods. Results Thirty women between 34 and 68 years of age were included in the study; except for one, all breast reconstructions were successful. The surgeons ranked VR higher than CTA in terms of better anatomical understanding and operative anatomical findings. In 72.4% of cases, VR models were rated having maximum similarity to reality, with no significant difference between the type of perforator anatomical course or complexity. In more than 70% of the cases, VR was considered to have contributed to determining the surgical approach. In four cases, VR imaging modified the surgical strategy, without any complications. Conclusions VR imaging was well-accepted by the surgeons who commented on its importance and ease compared with the standard CTA presentation. Further studies are needed to determine whether VR should become an integral part of preoperative deep inferior epigastric perforator surgery planning.
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Chae MP, Chung RD, Smith JA, Hunter-Smith DJ, Rozen WM. The accuracy of clinical 3D printing in reconstructive surgery: literature review and in vivo validation study. Gland Surg 2021; 10:2293-2303. [PMID: 34422600 PMCID: PMC8340329 DOI: 10.21037/gs-21-264] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/23/2021] [Indexed: 01/17/2023]
Abstract
A growing number of studies demonstrate the benefits of 3D printing in improving surgical efficiency and subsequently clinical outcomes. However, the number of studies evaluating the accuracy of 3D printing techniques remains scarce. All publications appraising the accuracy of 3D printing between 1950 and 2018 were reviewed using well-established databases, including PubMed, Medline, Web of Science and Embase. An in vivo validation study of our 3D printing technique was undertaken using unprocessed chicken radius bones (Gallus gallus domesticus). Calculating its maximum length, we compared the measurements from computed tomography (CT) scans (CT group), image segmentation (SEG group) and 3D-printed (3DP) models (3DP group). Twenty-eight comparison studies in 19 papers have been identified. Published mean error of CT-based 3D printing techniques were 0.46 mm (1.06%) in stereolithography, 1.05 mm (1.78%) in binder jet technology, 0.72 mm (0.82%) in PolyJet technique, 0.20 mm (0.95%) in fused filament fabrication (FFF) and 0.72 mm (1.25%) in selective laser sintering (SLS). In the current in vivo validation study, mean errors were 0.34 mm (0.86%) in CT group, 1.02 mm (2.51%) in SEG group and 1.16 mm (2.84%) in 3DP group. Our Peninsula 3D printing technique using a FFF 3D printer thus produced accuracy similar to the published studies (1.16 mm, 2.84%). There was a statistically significant difference (P<10-4) between the CT group and the latter SEG and 3DP groups indicating that most of the error is introduced during image segmentation stage.
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Affiliation(s)
- Michael P. Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Ru Dee Chung
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - David J. Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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Three-dimensional Printing in Plastic Surgery: Current Applications, Future Directions, and Ethical Implications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3465. [PMID: 33968548 PMCID: PMC8099403 DOI: 10.1097/gox.0000000000003465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Background Three-dimensional printing (3DP) is a rapidly advancing tool that has revolutionized plastic surgery. With ongoing research and development of new technology, surgeons can use 3DP for surgical planning, medical education, biological implants, and more. This literature review aims to summarize the currently published literature on 3DP's impact on plastic surgery. Methods A literature review was performed using Pubmed and MEDLINE from 2016 to 2020 by 2 independent authors. Keywords used for literature search included 3-dimensional (3D), three-dimensional printing (3DP), printing, plastic, surgery, applications, prostheses, implants, medical education, bioprinting, and preoperative planning. All studies from the database queries were eligible for inclusion. Studies not in English, not pertaining to plastic surgery and 3DP, or focused on animal data were excluded. Results In total, 373 articles were identified. Sixteen articles satisfied all inclusion and exclusion criteria, and were further analyzed by the authors. Most studies were either retrospective cohort studies, case reports, or case series and with 1 study being prospective in design. Conclusions 3DP has consistently shown to be useful in the field of plastic surgery with improvements on multiple aspects, including the delivery of safe, effective methods of treating patients while improving patient satisfaction. Although the current technology may limit the ability of true bioprinting, research has shown safe and effective ways to incorporate biological material into the 3D printed scaffolds or implants. With an overwhelmingly positive outlook on 3DP and potential for more applications with updated technology, 3DP shall remain as an effective tool for the field of plastic surgery.
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Galstyan A, Bunker MJ, Lobo F, Sims R, Inziello J, Stubbs J, Mukhtar R, Kelil T. Applications of 3D printing in breast cancer management. 3D Print Med 2021; 7:6. [PMID: 33559793 PMCID: PMC7871648 DOI: 10.1186/s41205-021-00095-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/31/2021] [Indexed: 12/24/2022] Open
Abstract
Three-dimensional (3D) printing is a method by which two-dimensional (2D) virtual data is converted to 3D objects by depositing various raw materials into successive layers. Even though the technology was invented almost 40 years ago, a rapid expansion in medical applications of 3D printing has only been observed in the last few years. 3D printing has been applied in almost every subspecialty of medicine for pre-surgical planning, production of patient-specific surgical devices, simulation, and training. While there are multiple review articles describing utilization of 3D printing in various disciplines, there is paucity of literature addressing applications of 3D printing in breast cancer management. Herein, we review the current applications of 3D printing in breast cancer management and discuss the potential impact on future practices.
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Affiliation(s)
- Arpine Galstyan
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.,Department of Radiology, Center for Advanced 3D Technologies, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Michael J Bunker
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.,Department of Radiology, Center for Advanced 3D Technologies, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Fluvio Lobo
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - Robert Sims
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - James Inziello
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - Jack Stubbs
- University of Florida, 3100 Technology Pkwy, Orlando, FL, 32826, USA
| | - Rita Mukhtar
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.,Department of Surgery, University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Tatiana Kelil
- University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA. .,Department of Radiology, Center for Advanced 3D Technologies, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA.
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Mayer HF. The Use of a 3D Simulator Software and 3D Printed Biomodels to Aid Autologous Breast Reconstruction. Aesthetic Plast Surg 2020; 44:1396-1402. [PMID: 32356154 DOI: 10.1007/s00266-020-01733-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
Abstract
Aesthetically pleasing and symmetrical breasts are the goal of reconstructive breast surgery. However, multiple procedures are sometimes needed to improve a reconstructed breast's symmetry and appearance. Since all breasts vary in terms of volume, height, width, projection, orientation, and shape, the lack of attention to these details at the moment of flap shaping in autologous reconstruction can lead to poor results. Recent advances in 3-dimensional (3D) surface imaging and printing technologies have allowed for improvement in autologous breast reconstruction symmetry. While 3D printing technology is becoming faster, more accurate, and less expensive, the technology required to obtain proper 3D breast images remains expensive, including laser scanners or 3D photogrammetric cameras. In this study, we present a novel use of an aesthetic surgery simulator software as an affordable alternative to obtaining 3D breast images and creating 3D printed biomodels to aid in the precise shaping of the flap. This approach aims to optimize aesthetic results in autologous breast reconstruction avoiding surgical revisions and reducing surgical times. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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On-Table Deep Inferior Epigastric Artery Perforator Mapping Made Simple. Plast Reconstr Surg 2020; 146:384e-385e. [PMID: 32842129 DOI: 10.1097/prs.0000000000007097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rozen WM, Bhullar HK, Hunter-Smith D. How to assess a CTA of the abdomen to plan an autologous breast reconstruction. Gland Surg 2019; 8:S291-S296. [PMID: 31709170 DOI: 10.21037/gs.2019.04.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The deep inferior epigastric perforator (DIEP) flap is recognised as the most popular option for autologous breast reconstruction. Planning of the DIEP flap involves pre-operative assessment of abdominal vascular anatomy with imaging, of which computed tomographic angiography (CTA) has become the mainstay. CTA enables detailed planning of a range of surgical steps, leading to reduced operative times and improved surgical outcomes. The value of CTA is only demonstrated when the relevant vascular anatomy is able to be demonstrated and appraised. For optimal analysis, a 64-slice multi-detector row CT scanner and imaging software including OsiriX™, Siemens InSpace™ or Horos™ are required. The seven major steps to consider include: (I) perforator size; (II) perforator angiosome; (III) intramuscular course; (IV) deep inferior epigastric artery (DIEA) pedicle; (V) venous anatomy; (VI) superficial inferior epigastric artery (SIEA) and superficial inferior epigastric vein (SIEV); and (VII) abdominal wall structure. These steps should also be reviewed when marking the patient and planning the flap intra-operatively. While CTA has superior sensitivity and specificity in mapping perforator anatomy it also faces challenges due to ionising radiation exposure, contrast-induced allergy and potential nephrotoxicity. Despite these challenges, the benefits of CTA to the individual patient has maintained its role in pre-operative planning of the DIEP flap.
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Affiliation(s)
- Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School Faculty of Medicine, Monash University, Frankston, Victoria, Australia
| | - Harmeet K Bhullar
- Peninsula Clinical School, Central Clinical School Faculty of Medicine, Monash University, Frankston, Victoria, Australia
| | - David Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School Faculty of Medicine, Monash University, Frankston, Victoria, Australia
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Rodkin B, Hunter-Smith DJ, Rozen WM. A review of visualized preoperative imaging with a focus on surgical procedures of the breast. Gland Surg 2019; 8:S301-S309. [PMID: 31709172 DOI: 10.21037/gs.2019.09.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Preoperative imaging has become a valuable tool in the planning of perforator flaps, and to date, computed tomographic angiography (CTA) has been shown to be the gold standard in this role. The evidence for this is a source of constant investigation, with advances in newer modalities coming to the fore. A literature review was undertaken to evaluate the current role of relevant imaging modalities in 'visualized surgery'-the ability to map anatomy prior to surgical incision. A focus is made on their accuracy in perforator mapping and correlation with improved clinical outcomes in the context of deep inferior epigastric artery perforator (DIEP) flap surgery. Other applications for preoperative imaging in breast surgery such as imaging of alternate donor sites or of the recipient site and imaging for volumetric assessment are also discussed. Preoperative imaging is integral to the planning of reconstructive breast surgery. This review has discussed the range of imaging techniques used to map and visualize perforator vasculature, and whilst there are varied clinical applications for the imaging modalities, CTA has been demonstrated to be the most precise and to confer the best clinical outcomes. Applications of the other imaging techniques are varied and these should remain as valid alternatives, particularly for patients where radiation or contrast exposure should be limited. Further studies could focus on the development of a more definitive protocol regarding the approach to preoperative imaging in breast surgery.
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Affiliation(s)
- Bridget Rodkin
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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3-DIEPrinting: 3D-printed Models to Assist the Intramuscular Dissection in Abdominally Based Microsurgical Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2222. [PMID: 31321193 PMCID: PMC6554155 DOI: 10.1097/gox.0000000000002222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/19/2019] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is available in the text. Harvest of the deep inferior epigastric vessels for microsurgical breast reconstruction can be complicated by an intricate and lengthy subfascial dissection. Although multiple preoperative imaging modalities exist to help visualize the vascular anatomy and assist in perforator selection, few can help clearly define the intramuscular course of these vessels. The authors introduce their early experience with 3D-printed anatomical modeling (to-scale) of the infraumbilical course of the deep inferior epigastric subfascial vascular tree to better assist in executing the intramuscular dissection.
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15
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Hoetzenecker K, Chan HHL, Frommlet F, Schweiger T, Keshavjee S, Waddell TK, Klepetko W, Irish JC, Yasufuku K. 3D Models in the Diagnosis of Subglottic Airway Stenosis. Ann Thorac Surg 2019; 107:1860-1865. [PMID: 30825452 DOI: 10.1016/j.athoracsur.2019.01.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/13/2019] [Accepted: 01/18/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Preoperative assessment of benign subglottic stenosis is usually performed by endoscopy and a computed tomography scan. Both diagnostic modalities have relevant limitations and sometimes an accurate assessment of the extent of disease is challenging. DESCRIPTION Based on computed tomography scans of benign glotto-subglottic stenosis and a control airway, color-coded three-dimensional (3D) models were produced using a commercially available 3D printer. The diagnostic relevance of 3D models was tested by means of a quiz. EVALUATION 52 thoracic surgeons from 4 North American and 1 European institution with different levels of experience in airway surgery were invited to test the diagnostic accuracy of 3D models against endoscopy films and computed tomography scans. 3D models were found to be superior to the other two diagnostic tools in terms of grading the extent of the stenosis and selecting the correct surgical strategy. The group of residents benefited the most from the 3D models. CONCLUSIONS 3D models of complex glotto-subglottic airway stenosis are a useful supplement of the preoperative assessment. In addition, they can serve as a teaching tool for residents and fellows.
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Affiliation(s)
- Konrad Hoetzenecker
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Harley H L Chan
- Guided Therapeutics Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Florian Frommlet
- Department of Medical Statistics (CEMSIIS), Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
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Chae MP, Hunter-Smith DJ, Rozen WM. Comments on “Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction” by S. Hummelink et al. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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