Dataset Information

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap.

ABSTRACT: Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute of the University of Bologna on eight donor cadavers. Then we performed the harvesting of the flap in vivo on eight patients. We introduced augmented reality (AR) to facilitate anatomical visualisation during free flap harvesting. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. No post-operative major or minor complications occurred. We encountered no post-operative functional issues on the donor or recipient sites, and good clinical healing was observed in all patients. In conclusion, we believe that the galea-pericranium flap could represent a new donor site for the harvesting of a periosteum carrier flap.

SUBMITTER: Battaglia S

PROVIDER: S-EPMC7408700 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap.

Battaglia Salvatore S Ratti Stefano S Manzoli Lucia L Marchetti Claudio C Cercenelli Laura L Marcelli Emanuela E Tarsitano Achille A Ruggeri Alessandra A

Journal of clinical medicine 20200713 7

Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute ...[more]

PMID: 32668591

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Project description:Image-guided surgery, prosthetic-based virtual planning, 3D printing, and CAD/CAM technology are changing head and neck ablative and reconstructive surgical oncology. Due to quality-of-life improvement, dental implant rehabilitation could be considered in every patient treated with curative intent. Accurate implant placement is mandatory for prosthesis long-term stability and success in oncologic patients. We present a prospective study, with a novel workflow, comprising 11 patients reconstructed with free flaps and 56 osseointegrated implants placed in bone flaps or remnant jaws (iliac crest, fibula, radial forearm, anterolateral thigh). Starting from CT data and jaw plaster model scanning, virtual dental prosthesis was designed. Then prosthetically driven dental implacement was also virtually planned and transferred to the patient by means of intraoperative infrared optical navigation (first four patients), and a combination of conventional static teeth supported 3D-printed acrylic guide stent, intraoperative dynamic navigation, and augmented reality for final intraoperative verification (last 7 patients). Coronal, apical, and angular deviation between virtual surgical planning and final guided intraoperative position was measured on each implant. There is a clear learning curve for surgeons when applying guided methods. Initial only-navigated cases achieved low accuracy but were comparable to non-guided freehand positioning due to jig registration instability. Subsequent dynamic navigation cases combining highly stable acrylic static guides as reference and registration markers result in the highest accuracy with a 1-1.5-mm deviation at the insertion point. Smartphone-based augmented reality visualization is a valuable tool for intraoperative visualization and final verification, although it is still a difficult technique for guiding surgery. A fixed screw-retained ideal dental prosthesis was achieved in every case as virtually planned. Implant placement, the final step in free flap oncological reconstruction, could be accurately planned and placed with image-guided surgery, 3D printing, and CAD/CAM technology. The learning curve could be overcome with preclinical laboratory training, but virtually designed and 3D-printed tracer registration stability is crucial for accurate and predictable results. Applying these concepts to our difficult oncologic patient subgroup with deep anatomic alterations ended in comparable results as those reported in non-oncologic patients.

Project description:BackgroundAugmented Reality (AR) represents an evolution of navigation-assisted surgery, providing surgeons with a virtual aid contextually merged with the real surgical field. We recently reported a case series of AR-assisted fibular flap harvesting for mandibular reconstruction. However, the registration accuracy between the real and the virtual content needs to be systematically evaluated before widely promoting this tool in clinical practice. In this paper, after description of the AR based protocol implemented for both tablet and HoloLens 2 smart glasses, we evaluated in a first test session the achievable registration accuracy with the two display solutions, and in a second test session the success rate in executing the AR-guided skin paddle incision task on a 3D printed leg phantom.MethodsFrom a real computed tomography dataset, 3D virtual models of a human leg, including fibula, arteries and skin with planned paddle profile for harvesting, were obtained. All virtual models were imported into Unity software to develop a marker-less AR application suitable to be used both via tablet and via HoloLens 2 headset. The registration accuracy for both solutions was verified on a 3D printed leg phantom obtained from the virtual models, by repeatedly applying the tracking function and computing pose deviations between the AR-projected virtual skin paddle profile and the real one transferred to the phantom via a CAD/CAM cutting guide. The success rate in completing the AR-guided task of skin paddle harvesting was evaluated using CAD/CAM templates positioned on the phantom model surface.ResultsOn average, the marker-less AR protocol showed comparable registration errors (ranging within 1-5 mm) for tablet-based and HoloLens-based solution. Registration accuracy seems to be quite sensitive to ambient light conditions. We found a good success rate in completing the AR-guided task within an error margin of 4 mm (97% and 100% for tablet and HoloLens, respectively). All subjects reported greater usability and ergonomics for HoloLens 2 solution.ConclusionsResults revealed that the proposed marker-less AR based protocol may guarantee a registration error within 1-5 mm for assisting skin paddle harvesting in the clinical setting. Optimal lightening conditions and further improvement of marker-less tracking technologies have the potential to increase the efficiency and precision of this AR-assisted reconstructive surgery.

Dataset Information

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap.

Publications

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap.

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