3D-printed, patient-specific DIEP flap templates for preoperative planning in breast reconstruction: a prospective case series

Study Design: Inlay cranioplasties following partial craniectomy in tumor or trauma cases and onlay cranioplasties for reconstructions of residual developmental skull anomalies are frequently performed using CAD-CAM techniques. Objective: In this case series, we present a novel cranial implant design, being a combination of 3D-printed titanium grade 23 and calcium phosphate paste (CeTi). Methods: The titanium patient-specific implant, manufactured using selective laser melting, has a latticed border with interconnected micropores. The cranioplasty is miniscrew fixed and its border zone subsequently partially filled with calcium phosphate paste to promote osteoinduction and osteoconduction. From April 2017 to April 2019, 8 patients have been treated with such a CeTi implant. The inlay cranioplasties were each time revision surgeries of complicated cases. Results: All implants were successful after a limited follow-up time (range 18-42 months). There were no dehiscences and no infections, and no complaints of thermal conduction. Conclusions: The proposed CeTi cranial implant combines the strength of titanium implants with the biological integration potential of ceramic implants and seems particularly resistant to infection, probably due to the biofunctionalized titanium surface and the antimicrobial activity of elevated intracellular free calcium levels.

Download Full-text

The L-shaped modification of the transverse upper gracilis (TUG) flap

European Journal of Plastic Surgery ◽

10.1007/s00238-020-01662-8 ◽

2020 ◽

Vol 43 (6) ◽

pp. 837-842

Author(s):

Juan Enrique Berner ◽

John M. D. Henton ◽

Adam Blackburn

Keyword(s):

Donor Site ◽

Case Series ◽

Diep Flap ◽

Level Of Evidence ◽

Skin Paddle ◽

Medial Thigh ◽

First Choice ◽

Prospective Case Series ◽

Tissue Flaps ◽

Therapeutic Study

AbstractA variety of free tissue flaps have been described for autologous breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is most microsurgeons’ first choice, there is no consensus regarding which is the second-best alternative. The transverse upper gracilis (TUG) flap has gained popularity for cases where the abdomen is not a suitable donor site. This musculocutaneous flap has the advantage of an easy dissection, allowing the harvest of tissue from the medial thigh area with the patient supine. However, drawbacks include a tedious donor site closure and a limited amount of soft tissue that can be transferred. The authors hereby present a modification of the TUG flap, introducing an L-shaped skin paddle: the L-shaped upper gracilis (LUG) flap. This alternative allows harvesting extra tissue from the medial thigh, while providing an easier donor site closure with the patient supine. A prospective case series of 14 LUG flaps is presented. No flap failures or episodes of fat necrosis were encountered; only one developed a donor site seroma that settled after drainage. The LUG flap is a useful development of the TUG flap concept providing up to 50% more tissue than a standard TUG flap with an aesthetically pleasing donor site closure which is useful for cases in which abdominal flaps are not possible.Level of evidence: Level IV, therapeutic study.

Download Full-text

Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex

OTO Open ◽

10.1177/2473974x18804492 ◽

2018 ◽

Vol 2 (4) ◽

pp. 2473974X1880449 ◽

Cited By ~ 8

Author(s):

Samuel R. Barber ◽

Kevin Wong ◽

Vivek Kanumuri ◽

Ruwan Kiringoda ◽

Judith Kempfle ◽

...

Keyword(s):

Augmented Reality ◽

Skull Base ◽

Surgical Planning ◽

Preoperative Planning ◽

Endoscopic Approach ◽

Physical Models ◽

Petrous Apex ◽

Patient Specific ◽

Lateral Skull Base ◽

3D Printed

Otolaryngologists increasingly use patient-specific 3-dimensional (3D)–printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D-printed patient-specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D-printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D-printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.

Download Full-text

Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction

European Journal of Plastic Surgery ◽

10.1007/s00238-018-1430-3 ◽

2018 ◽

Vol 41 (5) ◽

pp. 571-576 ◽

Cited By ~ 7

Author(s):

Stefan Hummelink ◽

Arico C. Verhulst ◽

Thomas J. J. Maal ◽

Dietmar J. O. Ulrich

Keyword(s):

Breast Reconstruction ◽

Patient Specific ◽

Autologous Breast Reconstruction ◽

3D Printed

Download Full-text

Development of Life-Size Patient-Specific 3D-Printed Dural Venous Models for Preoperative Planning

World Neurosurgery ◽

10.1016/j.wneu.2017.10.119 ◽

2018 ◽

Vol 110 ◽

pp. e141-e149 ◽

Cited By ~ 10

Author(s):

Figen Govsa ◽

Asli Beril Karakas ◽

Mehmet Asim Ozer ◽

Cenk Eraslan

Keyword(s):

Preoperative Planning ◽

Patient Specific ◽

3D Printed

Download Full-text

Early Experience With Virtual and Synchronized Augmented Reality Platform for Preoperative Planning and Intraoperative Navigation: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab188 ◽

2021 ◽

Author(s):

Robert G Louis ◽

Gary K Steinberg ◽

Christopher Duma ◽

Gavin Britz ◽

Vivek Mehta ◽

...

Keyword(s):

Augmented Reality ◽

Preoperative Planning ◽

Case Series ◽

Preoperative Imaging ◽

Patient Specific ◽

Total Resection ◽

Surgical Performance ◽

Aneurysm Clipping ◽

User Friendly ◽

Anatomic Information

Abstract BACKGROUND Virtual reality (VR) allows for presurgical planning. Intraoperatively, augmented reality (AR) enables integration of segmented anatomic information with neuronavigation into the microsurgical scene to provide guidance without workflow disruption. Combining VR and AR solutions may help guide microsurgical technique to improve safety, efficiency, and ergonomics. OBJECTIVE To describe a VR/AR platform that provides VR planning and intraoperative guidance via microscope ocular injection of a comprehensive AR overlay of patient-specific 360°/3D anatomic model aligned and synchronized with neuronavigation. METHODS Custom 360° models from preoperative imaging of 49 patients were utilized for preoperative planning using a VR-based surgical rehearsal platform. Each model was imported to SyncAR, the platform's intraoperative counterpart, which was coregistered with Medtronic StealthStation S8 and Zeiss or Leica microscope. The model was injected into the microscope oculars and referenced throughout by adjusting overlay opacity. For anatomic shifts or misalignment, the overlay was reregistered via manual realignment with known landmarks. RESULTS No SyncAR-related complications occurred. SyncAR contributed positively to the 3D understanding of patient-specific anatomy and ability to operate. Preoperative planning and intraoperative AR with 360° models allowed for more precise craniotomy planning and execution. SyncAR was useful for guiding dissection, identifying critical structures including hidden anatomy, understanding regional anatomy, and facilitating resection. Manual realignment was performed in 48/49 surgeries. Gross total resection was achieved in 34/40 surgeries. All aneurysm clipping and microvascular decompression procedures were completed without complications. CONCLUSION SyncAR combined with VR planning has potential to enhance surgical performance by providing critical information in a user-friendly, continuously available, heads-up display format.

Download Full-text

Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study

Journal of Personalized Medicine ◽

10.3390/jpm11080763 ◽

2021 ◽

Vol 11 (8) ◽

pp. 763

Author(s):

Anne M. L. Meesters ◽

Nick Assink ◽

Kaj ten Duis ◽

Eelco M. Fennema ◽

Joep Kraeima ◽

...

Keyword(s):

Acetabular Fracture ◽

Preoperative Planning ◽

Soft Tissue Injuries ◽

Ct Scans ◽

Screw Placement ◽

Patient Specific ◽

Surgical Guides ◽

Entry Points ◽

3D Printed ◽

Fracture Surgery

Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery.

Download Full-text