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The utility of three-dimensional models in complex microsurgical reconstruction

Archives of Plastic Surgery 2020년 47권 5호 p.428 ~ 434
Ogunleye Adeyemi A., Deptula Peter L., Inchauste Suzie M., Zelones Justin T., Walters Shannon, Gifford Kyle, LeCastillo Chris, Napel Sandy, Fleischmann Dominik, Nguyen Dung H.,
소속 상세정보
 ( Ogunleye Adeyemi A. ) - University of North Carolina Division of Plastic Surgery
 ( Deptula Peter L. ) - Stanford University Division of Plastic Surgery
 ( Inchauste Suzie M. ) - University of Washington Division of Plastic Surgery
 ( Zelones Justin T. ) - Plastic and Hand Surgical Associates
 ( Walters Shannon ) - Stanford University Department of Radiology
 ( Gifford Kyle ) - Stanford University Department of Radiology
 ( LeCastillo Chris ) - Stanford University Department of Radiology
 ( Napel Sandy ) - Stanford University Department of Radiology
 ( Fleischmann Dominik ) - Stanford University Department of Radiology
 ( Nguyen Dung H. ) - Stanford University Division of Plastic Surgery

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.

키워드

Microsurgery; Breast; Lymphedema

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